Clinic Collections – Specific Instructions
APPENDIX B – CLINICS:
1) The following must be filled out on the requisition: (fields may differ between forms)
Patient information:
- Clearly print last and first name. Verify spelling accuracy
- Patient phone number
- Patient id or social security number
- Patient complete address
- Date and time last food and drink
- Date and time specimen was collected
- Patient gender
- Patient date of birth
Requesting Physician:
- Physician name
- Physician address
- Physician phone number
- Physician NPI number
Specimen type sent:
- Mark specimen tubes collected and sent to the laboratory
Department of Health Reporting (required for heavy metals and infectious disease):
- Race
- Ethnticity
- Employer
- Occupation
- Employer address
- City / state / zip code
- Employer phone number
2) Mark tests ordered by physician or write in under other requests.
3) Place specimens and corresponding paperwork in shipping container for transport to the laboratory.
4) Refer to the section on Clinical Profiles & Tests for descriptions of specimen requirements and preservatives if needed. All clients are supplied with customized specimen collection kits, shipping containers and courier transport. If the tests ordered are not present in the catalog, or there are any further questions concerning collection, please contact Customer Service or your Account Executive at 800/445-6917.
5) If additional tests are ordered by an authorized person via the telephone, the laboratory subsequently attempts to obtain a written or electronic requisition within 30 days from the client and/or physician.