Test Requisition Forms
SELECT AND CLICK FROM THE BELOW LIST OF TEST REQUISITION FORMS (PDF):
Complete the test requisition form. Many of our test requisitions forms have specimen requirements and shipping instructions listed on the form. If additional information is needed (CPT codes, TAT, etc.) please see our test directory or call customer service at 1-877-717-3733.
Specimens without a Stanford Health Care EPIC Laboratory Label or EPIC printed order must be accompanied by a Stanford Health Care paper requisition with the following information:
- Patient's name & address
- Patient's gender
- Date of birth
- Medical record number (MRN) or unique identifier (ID#)
- Date and if appropriate, time of collection
- Test requested
- Type or source of the specimen
- Requesting physician/or Client Number with mailing address
- Clinical information if requested
- All applicable medical necessity ICD code(s)
- Complete billing and insurance information
- Providing additional relevant information may be important in alerting the laboratory of the need for special handling or specimen work-up.
Requisitions that do not contain this information (or for which the information is not legible) will be considered improperly identified and may delay testing. Tests sent to reference laboratories must have patient history information. The need for such information is indicated on the test request form.
For more information and guidance on specimen/case submissions: