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Molecular Diagnostic Laboratory Requisition Accession PHN / Healthcare Number M Patient Legal Name Last First Initial F Address City Prov. Patient Phone D O B DD MM YY LABORATORY MEDICINE AND PATHOLOGY Client Response Centre 780 407-7484 CAPITAL HEALTH REGION LABORATORIES DynaLIFE DX Copy to Name Physician Code Postal Code Lab Address Chart Bill Type CPL Ordering Physician / Practitioner Ordering Address / Location Report Location Code Report address if different Date specimen collected TIME...
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How to fill out what is a requisition form in phlebotomy
01
Obtain a copy of the phlebotomy requisition form pdf.
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Read and familiarize yourself with the instructions provided on the form.
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Fill out the patient information section accurately, including full name, date of birth, and contact information.
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Provide the name of the healthcare provider or facility ordering the phlebotomy services.
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Indicate the type of test(s) requested by checking the appropriate boxes or writing them in clearly.
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Include any necessary additional information such as specific instructions or test priorities.
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Sign and date the form, ensuring all required signatures are obtained if necessary.
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Make a copy of the completed form for your own records if desired.
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Securely send or deliver the form to the appropriate healthcare provider or laboratory.
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Phlebotomy requisition forms may typically be needed by healthcare professionals, such as doctors, nurses, or medical assistants, as they are responsible for ordering and organizing laboratory testing for their patients. Additionally, medical laboratories or diagnostic centers may also require these forms to process and perform the requested tests accurately.
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