Request Forms & Labelling

Question 1

Purpose of Requisition Forms

Answer 1

• The correct patient is tested
• The doctor’s orders are met
• The correct tests are performed at the proper time under the required conditions
• The patient is billed properly

Question 2

Different PathCare request forms

Answer 2

• General
• INR
• Insurance
• Sure Slim
• Visa
• Gynecologist
• Personalized

Question 3

General rules about request forms

Answer 3

• A lab request form must accompany every sample sent to the lab for testing
• Correct completion of the form is simple, but vital to providing a good lab service
• Always identify the patient correctly
• Complete the relevant sections of the request form as is applicable to the form in use at your site
• Use black permanent ink pens when completing the form
• No tipex is allowed on the request forms
• All forms must be completed in a legible handwriting and all tests should be clearly marked to avoid any confusion
• Hospital stickers containing patient demographic is missing any information, then it must be entered on the form by hand
• Always read the form carefully, if anything is unclear then you must seek clarification before progressing.
• Do not change anything on the form without authorization

Question 4

ID relevance

Answer 4

For identification purposes. Many medical aids also needs this information

Question 5

Gender & Date of Birth relevance

Answer 5

Assists in interpretation on numerous test results. the reference ranges for certain lab tests differ according to the age & sex of the patient, e.g. the normal reference for a full blood count on an adult male is different to that of a month old baby boy.

Question 6

Clinical Data relevance

Answer 6

Is required to facilitate the accurate interpretation of the lab results. lab personal only sees the specimen, not the patient:
* Diagnosis - the diagnosis is usually written on the request form by the referring doctor or nursing sister on his behalf
* Sometimes tests are written here

Question 7

Present Medication relevance

Answer 7

Medication the patient may be taking can influence the interpretation of the results, e.g.
* Oral contraceptives will influence progesterone & oestrogen results
* Warfarin | Coumadin dosages are needed for INR , heparin, IV or subcutaneous (PTT) tests
* Administration of radiographic dyes prior to blood collection

Question 8

LMP (First day of Last Menstrual Period) relevance

Answer 8

A special place has been allocated for this information
the interpretation of many hormone tests are dependent on the LMP:
* B-HCH (Pregnancy test)
* Progesterone
* Female Infertility Profile

Question 9

Fasting Status relevance

Answer 9

Mark the appropriate block ( Cholesterol, Lipo, Glucose level, GTT) the reference range for fasting specimens is different to those of random specimen

Question 10

Missing | Omitted information
- Referring Doctor -

Answer 10

The doctor’s initials & surname are required to ensure that the correct doctors get the patient’s results, remember there may be many different doctors with a common surname

Question 11

Missing | Omitted information
- Doctor’s Code -

Answer 11

This is our computer code for a given doctor

Question 12

Missing | Omitted information
- Doctor’s PR -

Answer 12

Needed by medical aids to ensure payment

Question 13

Missing | Omitted information
- Copies to Doctors -

Answer 13

If the referring doctor needs a copy of the results to be sent to another doctor, the ‘copy’ doctor’s initials & surname must be written on the form

Question 14

Missing | Omitted information
- Hospital & Ward -

Answer 14

These blocks are for hospitalized patients. The name of the hospital & the ward name or number will ensure that the relevant hospital & wards receive a copy of the patient’s results

Question 15

Missing | Omitted information
- Urgent -

Answer 15

When results are needed urgently, the details of the person to whom these results can be phoned or faxed must be written in this space

Question 16

Billing Demographics
- Account to -

Answer 16

• The person responsible for the account is not necessarily the patient.
• If the patient belongs to a medical aid, the name of the principal member of the medical aid is entered here

Question 17

Billing Demographics
- Address -

Answer 17

This space is for the residential address of the person responsible for settling the account

Question 18

Billing Demographic
- Postal Address -

Answer 18

• If the postal address differs from the residential address, it is to be noted here.
• A copy of the account will be posted to the person even is we claim directly from the medical aid

Question 19

Billing Demographic
- Telephone number (home & work) , Employer -

Answer 19

This information facilitates communication with the person concerned should this become necessary

Question 20

Billing Demographic
- Medical Aid & Number -

Answer 20

• Both the name & the membership number of the medical aid are necessary to ensure payment
• ICD 10 codes

Question 21

Incorrectly labelled specimen | Name incorrectly captured

Answer 21

• Results attributed to incorrect patient / not given to the patient at all
• Upset client & patient
• Incorrect treatment given
• Patients fail to recover / takes longer to recover
• Additional medical costs to patient
• Incorrect patient billing
• Litigation

Question 22

Tests incorrectly captured

Answer 22

• Wrong tests would be performed
• The doctor would be upset
• There would be a delay in performing the correct tests
• A delay in patient treatment
• Additional costs to the lab to perform the correct tests
• Possible litigation

Question 23

Incorrectly captured Requisition number

Answer 23

The result of the tests will not be linked to the patient & will therefore be useless