Get Laboratory Request Form Template

The test requisition combines patient registration information, billing information, specimen information, barcoded specimen labels and a provider order for confirmation of testing.

The standard LRF contains demographic data and other information, such as location of the patient, laboratory information, physician's name and signature, telephone number of the requesting physician, amongst others.

Laboratory requisitions must include doctor's name; patient's name, age, date of birth, and identification number; tests to be performed; and date and time for specimen collection.

What Patient details (name, address, telephone number, birth date, gender, etc.) Requester details. Type of primary sample. Examination(s) requested. Clinical information relevant to the laboratory. Date, time and place of sample collection. Date and time of receipt of the sample at the laboratory.

What is a lab requisition form? A lab requisition form is used by healthcare professionals to request laboratory tests such as urine or blood testing. They are also called test requisition forms. When blood, urine, or tissue is sent to a lab from a doctor's office a lab requisition form is required.