Laboratory Requisition Form Procedures

The proper completion of the requisition form is critical to ensuring the appropriate matching of specimen and subsequent test results to the respective patient. We have designed test requisition forms to make submitting specimens easier and faster.

1- COMPLETE a separate test requisition for each patient.

2- RECORD the following:

a. Complete account information including name and address
b. Ordering provider’s first and last name
c. Patient name, date of birth, gender
d. Patient’s home phone number, including area code
e. Collection date and time
f. Billing/Insurance information, as necessary (include patient address, insurance plan/number, and policy holder name).
g. List symptom description as ‘multiple med use’ and ICD-10 codes
h. Patient address for lead reporting

3- ENTER  BPP15 or Clip14 under Custom Profile.
4-SIGN  The ordering provider should sign the requisition at the bottom of the requisition whenever possible. Should the ordering provider not sign the requisition, order documentation from the patient’s medical record MUST be made available to PDS when requested.

5-LABEL each specimen with a requisition sticker from top left hand corner of the requisition. Write the patient’s full name on the specimen container.

6- SUBMIT the top white copy with the specimen(s).

7- The yellow copy may be sent to Physician.

8- The pink copy may be retained for your records.

Specimen Collection and Transport Guidelines

The clinical information obtained from a urine specimen is influenced by the collection method, timing and handling. As with any type of laboratory specimen, there are certain criteria that need to be met for proper collection and transportation of urine specimens. This will ensure proper stability of the specimen and more accurate test results.

  • All urine collection and/or transport containers should be clean and free of particles or interfering substances.
  • To avoid contamination, do not touch the inside of the cup or the cap of the urine collection cup.
  • The collection and/or transport container should have a secure lid and be leak-resistant. Leak resistant containers reduce specimen loss and healthcare worker exposure to the specimen while also protecting the specimen from contaminants.
  • Proper labeling should be applied to the collection container.

Urine Specimen Transport

  1. For specimens transported by PDS couriers:
  • Place the primary container(s) into a plastic bag. (Only one patient per bag.)
  • Place the appropriate request form(s) outside of the plastic container, but inside the plastic bag.
  • Then place the bag into a leak proof, temperature-controlled carrier for transport to ACL.

  2.   When shipping specimens by commercial courier:

  • The urine container is the primary container. Primary containers must be crush proof and appropriately sealed to prevent leakage. 
  • Plastic bags with a seal closure are provided by PDS. The secondary container should also include absorbent material to absorb the entire contents of the primary container should it break in transit.
  • Cardboard mailing cartons are supplied by ACL. Group submissions should be packaged in cardboard boxes with enough packing material to prevent breakage. In all cases, the outer carton must be labeled with the universal biohazard symbol in accordance with Federal Regulation.