To request printed test requisitions, please contact an Integrated Oncology representative:
Brentwood/Phoenix Clients call 866-875-2271
Shelton/New York Clients call 800-447-5816
Test Requisition Instructions
Complete the test requisition with all requested information. Ensure all required fields are filled out and information submitted is accurate.
- Client: account #, name, department, address, ordering physician, phone #, physician/authorized signature
- Patient: name, gender, DOB, address
- Billing: insurance company name, policy #, group # (attach face sheet and copy of insurance card)
- Specimen: hospital status when sample collected, specimen ID #s, body site, collection date and time
- Clinical: ICD-CM, clinical indication (attach clinical history and pathology reports), clinical status
- Tests/Services: select tests to be performed
Send a signed, printed copy of the test requisition with your specimens. Please ensure that all information on the test requisition matches the information on the specimens sent (i.e. blocks, slides, tubes).