TEST REQUEST

Laboratory tests are performed on the written request of a licensed physician or other allied health professional (AHP) as approved by state stature and medical staff bylaws.

Nursing unit staff place orders in the Care Manager computer system for inpatients.

All outpatient orders for the Laboratory must be in writing. Outpatient Requisitions are available on request from the Customer Service Manager.

Manual requisitions are used for inpatient orders when the manual back-up system is initiated during computer downtime, for tests not orderable in the computer system and for Flow Cytometry and Surgical Pathology specimens. These forms, CT-041 (Rev 3/04) can be ordered through purchasing/materials management and each patient area is responsible for keeping a sufficient quantity on hand.

The following information must legible and be on each requisition and each copy of the requisition submitted:

Note: incomplete requisitions and incompletely labeled or mislabeled specimens will be discarded in the Laboratory and a new collection requested.

• patient's full name

• patient's NHHN medical record number or other unique identifying number

• patients date of birth for outpatient requests

• requesting physician's full name (first and last)

• test(s) requested, be specific

• patient diagnosis

• date and time of specimen collection

• name, initials or LIS Tech Code of person collecting specimen

• source of specimen (if necessary)

• special instructions (if necessary)

• If requesting viral isolation cultures, include type of infection and/or virus expected.

• for therapeutic drug tests, provide date and time of last dose and mode of delivery, if applicable.

• for creatinine clearance, provide height and weight of patient

• for PT or aPTT, provide type of anti-coagulant

• for 24 hour (or longer) specimen collections, record start time and completed time

• outpatient requisitions must be also include appropriate billing information