Here is an example of a form filled out properly please choose "open" to open the example in powerpoint.
Electronic
order entry or paper requisition forms may be used to initiate laboratory tests.
It is the responsibility of individuals performing electronic order entry of
laboratory tests to accurately and completely transcribe the tests ordered by
the physician. A laboratory order must include:
The patient's
last name, first name, medical record number (MRN)
Patient
location
Ordering
physician including secondary provider
Diagnostic
code(s) for requested tests
Suffix
code (outpatient)
Specimen
collection date and time
Individual
tests meeting medical necessity or HCFA approved panels, or tests where the
physician has acknowledged medical necessity requirements and reimbursement
limits
A paper
requisition must accompany every surgical pathology and cytopathology specimen
