Proper completion of requisition forms is essential for correct and timely processing, resulting, and billing of patient samples. The following is a list of elements required for all requisition forms.

• Patient’s Full Name
• Address
• Date of Birth
• Sex
• Name of Submitting Facility
• Name of Physician
• Clinical History
• Insurance and/or billing information
• Date of Collection
• Source of Specimen
• Place of service, e.g. inpatient or outpatient if from a hospital

Do not hesitate to contact Physicians Laboratory with any questions regarding specimen submission.