Complete the test requisition with all requested information. Ensure all required fields are filled out and information submitted is accurate.

• Client: account #, name, department, address, ordering physician, phone #, physician/authorized signature
• Patient: name, gender, DOB, address
• Billing: insurance company name, policy #, group # (attach face sheet and copy of insurance card)
• Specimen: hospital status when sample collected, specimen ID #s, body site, collection date and time
• Clinical: ICD-CM, clinical indication (attach clinical history and pathology reports), clinical status
• Tests/Services: select tests to be performed

Send a signed, printed copy of the test requisition with your specimens. Please ensure that all information on the test requisition matches the information on the specimens sent (i.e. blocks, slides, tubes).