Lab Request Form Template

A lab request form (also called a lab requisition) is a document submitted by a healthcare provider to order diagnostic testing on a patient specimen. It specifies what tests to run, provides patient demographics and insurance information, and includes any clinical context relevant to interpreting the results. It's the starting point for every specimen that comes through a lab.

It ensures every order arrives with the information needed to process it — reducing delays, minimizing errors, and creating a documented chain of custody from order to result. Standardized forms also make billing easier, since required insurance and diagnosis codes are collected upfront.

The form should cover patient identity, the ordering provider, the tests requested, and any relevant clinical context. Consider including:

• Patient name, date of birth, and medical record number
• Ordering provider name and NPI number
• Date and time of specimen collection
• Specimen type and collection site
• Tests ordered (with CPT codes if applicable)
• Diagnosis codes (ICD-10)
• Insurance information and authorization number if required
• Special handling or priority instructions

Add a priority field early in the form so urgent requests are immediately flagged. Connect the form to a notification system that alerts lab staff in real time when a STAT request is submitted. For time-sensitive specimens, you can also add a field for specimen collection time to calculate turnaround time expectations automatically.

Use a multi-select field for test ordering that groups individual tests into common panels (basic metabolic panel, CBC with differential, etc.) while also allowing individual test selection. Conditional logic can reveal additional fields when specific tests are selected — an order for blood cultures, for example, might prompt questions about antibiotic history that a lipid panel wouldn't need.