Test Request Instructions
TEST REQUEST INSTRUCTIONS
Instructions for Completing the Coagulation Laboratory Test Requisition Form
- Complete a separate Test Requisition for each patient.
- Please use a pen to complete the form. Be sure to PRINT legibly.
- Record the Following
- Your client account number or hospital name/address if not already there.
- Patient name, patient ID (not SSN), date of birth, sex, lab ID number
- Collection date/time
- Ordering physician name
- Complete medication history area (if applicable). It is especially important to note any COUMADIN, HEPARIN, or direct thrombin inhibitors (such as Lepirudin or Argatroban) in use.
- Mark box(es) with an X or checkmark indicating the tests requested. If you wish to decline automatic reflexing of a test, you must mark the box provided for this purpose.
- If requesting the Heparin Level/anti Xa Assay, mark the type of heparin the patient is receiving. This information MUST be provided; otherwise the laboratory will run the assay as if the patient is receiving unfractionated heparin.
- Write the required patient information on the specimen container. Refer to Specimen Labeling Policy.
- Keep a copy of the requisition for your records.
- Fold a copy of the requisition with the patient information facing out.
- Place the labeled specimen(s) in the ziplock portion of the specimen bag. Place the folded test requisition into the outside pocket of the specimen bag.
- If multiple transport temperatures are required, place specimen(s) in separate bags. Refer to the Shipping/Packing Instructions.