Test Requisition Form | Medical Diagnostic Laboratories

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<strong>Office:</strong> <p>609-570-1000</p> </li> <li class="group"> <strong>Fax:</strong> <p>609-570-1050</p> </li> <li class="hours group"> <strong>Hours:</strong> <p><strong>Mon-Fri:</strong> 8:00am - 10:00pm EST<br> <strong>Sat:</strong> 9:00am – 5:30pm EST </p> </li> <li class="email"> <a href="mailto:customerservice@mdlab.com" class="email_cs"><icon class="icon">e</icon></a> </li> </ul> <ul id="billing" class="tab"> <li class="group"> <strong>Toll Free:</strong> <p>877-333-9233</p> </li> <li class="hours group"> <strong>Hours:</strong> <p><strong>Mon-Fri:</strong> 8:00am - 10:00pm EST<br> <strong>Sat:</strong> 9:00am – 5:30pm EST </p> </li> <li class="email"> <a href="mailto:BCS@mdlab.com" class="email_cs"><icon class="icon">e</icon></a> </li> </ul> </div> <div id="gbs"> <h2><strong>GBS</strong> Hotline</h2> <div> 877.635.4277 <span>Physician's Only</span> </div> </div> </section> <section class="f_col"> <div class="flex_wrap"> <div id="location" class="iconP" href="" 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class="icon">D</icon></h5> <ul id="physician_links" class="qLink"> <li> <a href="https://www.lifepoint18.com/MDLAB/lpi3/?event=auth.login">View Test Results</a> </li> <li> <a href="https://www.mdlab.com/clients/supplies/">Supply Requests</a> </li> <li> <a href="https://www.mdlab.com/clients/invoices/">Pay Invoice</a> </li> <li> <a href="https://www.mdlab.com/resources/tests/">Test Catalog</a> </li> <li> <a href="https://www.mdlab.com/resources/forms/">Forms</a> </li> </ul> </section> </div> </div> </div> <main id="content" class="wrapper"> <h2 class="med_hl sfont">Instructions for Completing a Test Requisition Form</h2> <p class="spec_txt no-marg">A test requisition form must be submitted for each patient. If multiple specimens are submitted on one patient which require separate transportation conditions, please use separate biohazard bags and forms.</p> <div class="btns marg center"> <a href="http://www.mdlab.com/forms/OBGYN_Inf_Dis_Test_Req.pdf" class="dl_btn iconP subcol"><span class="subcol"><strong>OB/GYN </strong> Infectious Disease Test Requisition Form</span></a> <form id="test_reqs_request" action="https://www.mdlab.com/resources/forms?test_req=4" method="post"> <input type="hidden" name="category" value="4"> <button class="btn_note subcol"><em>View All Test Requisition Forms</em></button> </form> </div> <div class="step_box"> <section class="step_info"> <h3>Ordering Physician/Laboratory</h3> <p>All ordering physicians must provide complete information, including the NPI number and/or UPIN #, the first time a specimen is submitted. Once that physician is added to our database, the physician’s name, office location and MDL Account # are sufficient.</p> </section> <figure class="animation fadeR"><img src="https://www.mdlab.com/images/test_req1.jpg?v=1701712444" alt="" width="522"></figure> </div> <div class="step_box left"> <section class="step_info"> <h3>Patient Information</h3> <p>Please complete all of the following information in this section. Not only is it important for positive patient identification, but also for billing purposes.</p> <ul class="req_fields"> <li><span class="req">Patient Name</span></li> <li><span class="req">Sex</span></li> <li><span>Mailing Address</span></li> <li><span>SSN</span></li> <li><span class="req">Date of Birth</span></li> <li><span>Phone Number</span></li> </ul> </section> <figure class="animation fadeL"><img src="https://www.mdlab.com/images/test_req2.jpg?v=1701712444" alt="" width="556"></figure> </div> <div class="step_box"> <section class="step_info"> <h3>Billing Information</h3> <p>One billing option must be checked. If no information is provided, the patient will be billed directly. If submitting third party information, either complete all areas or simply attach a photocopy of the front and back of the patients insurance card. Be sure to include appropriate diagnosis codes when submitting specimens for third party billing patients.</p> </section> <figure class="animation fadeR"><img src="https://www.mdlab.com/images/test_req3.jpg?v=1701712444" alt="" width="555"></figure> </div> <div class="step_box left"> <section class="step_info"> <h3>Specimen Information</h3> <p>The date of collection is a very important, often overlooked piece of information. If the actual transport time exceeds the recommended time frame, then the integrity of the results may be compromised. It is also essential in determining the order of specimens in serial testing. Please identify the source of any specimen other than blood. This is particularly important for biopsies and body fluids.</p> </section> <figure class="animation fadeL"><img src="https://www.mdlab.com/images/test_req4.jpg?v=1701712444" alt="" width="542"></figure> </div> <section class="sbox"> <strong>Finally...</strong> <h3 class="subcol">Don’t forget to indicate all tests being ordered on the Test Requisition!</h3> </section> </main> <footer class="bgc"> <span id="foot_pad"></span> <div id="top_foot"> <div class="wrapper"> <ul id="foot_links"> <li><a href="https://us232.dayforcehcm.com/CandidatePortal/en-US/ggg/SITE/MDLCareerSite">Careers</a></li> <li><a href="https://www.mdlab.com/privacy/">Privacy Policy</a></li> <li><a href="https://www.mdlab.com/terms/">Terms of Use</a></li> </ul> <ul id="social"> <li>Follow Us</li> <li> <a href="https://twitter.com/GenesisBioJobs" target="_blank"><i class="icon">t</i></a> </li> <li> <a href="https://www.linkedin.com/company/genesis-biotechnology-group" target="_blank"><i class="icon">i</i></a> </li> </ul> 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