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    Requisition Guidelines
    Provider Guidelines

    Requisition Guidelines

    Instructions and requirements for healthcare providers submitting lab orders and custom testing panels.

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    Completing the Requisition

    To ensure proper processing and avoid delays, all requisition forms must be completed accurately and thoroughly.

    Patient Information: Must include the patient's full legal name, date of birth, biological sex, and contact information.

    Provider Details: The ordering provider must supply their NPI number, clinic address, and a valid signature.

    ICD-10 Diagnosis Codes: All lab orders must include appropriate ICD-10 diagnosis codes to establish medical necessity.

    Special Order Types

    Please follow these instructions for specific types of orders:

    • Custom Panels: Write the exact test name and preferred methodology in the 'Custom Orders' section.
    • Stat Orders: Clearly mark the requisition as 'STAT' for urgent testing needs.
    • Critical Results: Values outside life-threatening parameters will be immediately reported via phone.

    Submission Process

    Electronic Submission

    Preferred method. Submit orders directly through our secure provider portal for fastest processing and tracking.

    Fax Submission

    Fax completed forms to our secure line. Ensure all pages are transmitted clearly and confirm receipt if urgent.

    Patient Walk-ins

    Provide the patient with a printed and signed requisition form to bring to the collection site.

    Downloadable Requisition Forms

    Standard Lab Requisition Form

    Standard form for ordering routine blood work, urinalysis, and common panels.

    PDF • 145 KB

    Custom Panel Requisition Form

    Use this form when ordering specialized tests or custom biomarker panels not listed on the standard form.

    PDF • 112 KB

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