Request Forms & Labelling Flashcards
Purpose of Requisition Forms
- 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
Different PathCare request forms
- General
- INR
- Insurance
- Sure Slim
- Visa
- Gynecologist
- Personalized
General rules about request forms
- 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
ID relevance
For identification purposes. Many medical aids also needs this information
Gender & Date of Birth relevance
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.
Clinical Data relevance
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
Present Medication relevance
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
LMP (First day of Last Menstrual Period) relevance
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
Fasting Status relevance
Mark the appropriate block ( Cholesterol, Lipo, Glucose level, GTT) the reference range for fasting specimens is different to those of random specimen
Missing | Omitted information
- Referring Doctor -
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
Missing | Omitted information
- Doctor’s Code -
This is our computer code for a given doctor
Missing | Omitted information
- Doctor’s PR -
Needed by medical aids to ensure payment
Missing | Omitted information
- Copies to Doctors -
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
Missing | Omitted information
- Hospital & Ward -
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
Missing | Omitted information
- Urgent -
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
Billing Demographics
- Account to -
- 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
Billing Demographics
- Address -
This space is for the residential address of the person responsible for settling the account
Billing Demographic
- Postal Address -
- 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
Billing Demographic
- Telephone number (home & work) , Employer -
This information facilitates communication with the person concerned should this become necessary
Billing Demographic
- Medical Aid & Number -
- Both the name & the membership number of the medical aid are necessary to ensure payment
- ICD 10 codes
Incorrectly labelled specimen | Name incorrectly captured
- 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
Tests incorrectly captured
- 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
Incorrectly captured Requisition number
The result of the tests will not be linked to the patient & will therefore be useless
