We have designed test requisition forms to make submitting specimens to a Legacy Laboratory easier and faster. You can use a single requisition form to submit cultures, Pap smears, tissue, blood or urine specimens. Requisitions come pre-printed with your client number, clinic name and address and physician name(s). When completing a requisition, please make sure the ordering physician name is circled. For your convenience, we can preprint commonly ordered tests, panels or combinations of tests unique to your office on the requisition.
Each requisition form has codes unique to your office and physicians. Please use only original requisition forms (photocopies are not acceptable). Return the top copy with the specimen(s) and keep the Physician copy for your records.
Completing the Test Requisition Form
We provide clinical laboratory requisitions that allow you to submit tissue, Pap smears, blood, urine or microbiology specimens using a single form.
Clearly mark the tests you want and include special information, such as the number of hours fasting, medications and last dose on the requisition form. Also indicate the source of the tissue, Pap, body fluid or microbiology specimens.
Any individual with the consent of the person being tested may request testing for drugs of abuse directly from the laboratory. Use the Toxicology Chain-of-Custody requisition for all employment-related testing.
Please see the sample test requisition for an example of the requisition form. See sample billing requisitions for specific examples of how to complete the requisition form to have us bill your office, patient, Medicare/Medicaid or other insurance. See also Active Local Coverage Determinations (LCD) by state, the January 2013 NCD Coding Policy Manual and Change Report, and the Annual Physician Notice of Laboratory Compliance.
Test Requisition Required Information
Three patient identifiers are required on the requisition.
- Full Legal Name (required)
- Date of Birth (required)
- Social Security Number
- Patient Address (required for patient/insurance billing)
Please Note: Two patient identifiers are required on the specimen labels. See Labeling Specimens.
To keep a patient's identity confidential, you may use an internal patient identifier instead of the patient's name. Our system can accommodate up to 25 characters. This identifier will appear on the report instead of the patient's name. Direct Client bill is the only payment option available in this situation.
Priority Handling is available for non-emergent but time sensitive situations. This option provides services within a defined timeframe. Contact your account service representative or Courier Dispatch, 503-413-5200, for additional information.
STAT Specimen Information
STAT courier services are not available to all locations. Contact Courier Dispatch, 503-413-5200, for STAT transportation availability. STAT results are available, for most tests designated as a STAT test, within one hour of receipt by the performing laboratory.
A STAT request indicates a potentially life-threatening situation. Due to the resource intensive nature of STAT service, please consider requesting Priority Handling for non-emergent but time sensitive situations.
Tests available on a STAT basis are marked with an asterisk (*) to the left of the test name in the Test Table. STAT requests, for tests not marked with an asterisk, will be referred to a pathologist for consultation. Please place a STAT label on the requisition, the specimen container and the transport bag. Contact Courier Dispatch and request STAT service.
Result will be communicated per your instructions on the requisition. Please provide a telephone or pager number. In lieu of instructions, results will be faxed to the fax number on file and, after 5 pm, phoned to the ordering provider. For most electronic medical records and the Legacy WEBLink, results will be available on verification by the performing technologist.
STAT labels are available through Supply Distribution FAX at 503-413-5086.
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The components to our most commonly ordered diagnostic and prenatal panels, as well as our Reflex Testing Policy, are noted on the back of the requisition.
Specimen Requirement Codes
As a quick reference, we have printed specimen requirements next to the test names on the requisition. A key to the codes can be found on the requisition above the individual test section.
This area is provided for ordering tests not listed on the test requisition and can be customized to fit your ordering needs.
To request that a copy of a report be sent to another physician, simply indicate the physician's full name and address in the "duplicate report to" space provided on the requisition. The second physician's name will print in the "copies to" space on your report. This notifies you that the second physician received a copy. The second physician's copy will have the ordering physician's name indicated in the "provider" space on the report.
Notify our printing representative at 503-413-5046 of changes to your unique office or physician information so we can keep your forms up to date. A reorder reminder, printed on hot pink paper, will be found in your requisitions. You may return the reminder with your courier or call 503-413-5046 to reorder requisitions.
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Submitting Orders with Multiple Storage Requirements
A patient's order may include tests with different specimen storage requirements. All bags or packages associated with an order should be sent to the laboratory at the same time. For efficient billing and tracking, submitting orders on a single requisition number is optimal. The following procedure will help the laboratory receive the specimens ordered on a single requisition number, but split across different storage requirements.
- On the requisition, indicate the ordered tests.
- Make a copy of the requisition for each additional temperature.
Note: All patient and testing information may not transfer legibly through all copies of a multi-copy form. Please send a photocopy of the original requisition with each specimen bag.
- Mark the original and associated copies to indicate the number of packages and the storage temperature.
Example 1: An order for a Protime (Room Temperature storage) and a UA (Refrigerated) would need two bags. Mark the original 1 of 2 Room Temperature. Mark the copy 2 of 2 Refrigerated. See Example 1a and 1b on how to prepare the forms.
If the order requires three different storage temperatures, the original and two copies would be marked 1 of 3 Room Temperature, 2 of 3 Frozen.
- Cross off the tests on each requisition that are not being sent in the associated specimen bag. For Example 1 above, the original requisition sent with the Room Temperature sample would show a Protime and a UA w/C&S if indicated. Copy 1 sent with the Refrigerated sample would show a Protime and a UA w/C&S if indicated.
For requisitions call 503-413-5046.
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