Test Requisitions

Separately completed Test Requisition Form should be included for each patient; please type or print clearly. Using a packing list for documentation is highly error prone. Do not send specimens to Quality Laboratory Service without an accompanying Test Requisition Form or computer link-generated packing list.

Quality Laboratory Service can provide pre-printed customized Client Requisition Forms.
Please call Client Services at 718-646-5100 to open a new account or to order Test Requisition Forms.

The following information must be included if you use your own computer-generated test requisitions:

• Name and address of referring client.
• Sending client's Account Number with Quality Laboratory Service.
• Indication of Quality Laboratory Service as receiver of the order.
• Required patient demographic (patient name, sex, date of birth), complete billing and clinical information.
• ICD-9 Diagnosis code must match each requested test.
• Correct Quality Laboratory Service test code with full name of requested test (no truncated names).

Incomplete Test Requisition Forms

If a test is ordered that can be performed by several different methodologies and the method is not specified on the Test Requisition Form, Quality Laboratory Service will perform the test by the method which generally has the greatest clinical utility.

Add-on

Provided there is sufficient specimen volume, additional tests can be ordered on a previously submitted specimen; please contact Client Services, 718-646-5100. Authorization from the physician who originally referred the specimen(s) to Quality Laboratory Service Laboratory is required in order to process add-on test requests. Written verification (via Fax or mail) must be provided, as required by the College of American Pathologists and CLIA '88.

Please call Client Services at 718-646-5100 to order Test Requisition Forms