To ensure quick lab results, we have downloadable requisition forms available. For more information, please contact account management. A requisition is a situation wherein one person makes a formal request for just about anything. Laboratory supply order formsterling regional medcenter. A client supply order form is a document that is used to process supply request orders from the client to the manufacturer, producer, or warehouse. Ur medicine labs supply order form requisition side fax to 585 2959622 or call client services 585 3502600 option 3 or tollfree 8007474769 cytology other printed items please note. Labcorp along with integrated genetics is a onesource laboratory provider offering testing and services from screening to diagnosis, and counseling to support the continuum of your patients care.
If you are interested in becoming a labcorp client, you may complete this form to request a visit to your office by one of our representatives to discuss our services. If you need to order specimen collection supplies from baycare laboratories, please print out the form below and fax to our supplies department or call 866 3005010. Whenever one wishes to order more materials from their stock department, theyll have to issue a requisition that formally asks for the the specific item or items they need and the quantity that they need it in. Fully customized test request forms may be formatted to meet a clients specific needs or testing requirements. Viral transport swab kit which are typically used to collect viral specimens i. Acl makes ordering test supplies online easy and hassle free. Fedex option hh5000 labinabox for when its necessary to ship the specimen via fedex. Item item tubesneedles microbiology 3 ml mint green li heparin bd367960 ea flat eswab white aerobicanaerobic r723480 ea bag 3. Client supply order form arup form 0002, rev 2 january 2020 page 1 of 1. By calling 8885224452 and connecting with our sales team. It also shows the client s name, contact details, and payment method. Supply order form download pdf for miscellaneous supplies not listed below, please fill in the appropriate information in the commentsspecial orders field on the form.
Helps you to find out when you should order reagents, disposables, equipment and in what quantity. Client supply form 2017 1172017 please order supplies in quantities that will be used before expiration dates. Needle holder green 3ml vac barrier 4 ml green top. This client supply order form shows the order information like the order number, order type, order date, and the ordered items. Laboratory requisition place patient label here or write. Supplies order forms a4 pad 50 telephone results report forms a5 pad 50 other qty.
Labcorp will provide you with your account number and welcome information. Ahs laboratory services reagent room manual reagent room client supply order provincial form prrsor00001 effective date. To begin ordering supplies online, you must be an acl client and have an active online account. Laboratory client supply order form please allow up to 5 days for delivery fax order to. Please indicate whether you are the labcorp customer or a collection facility ordering supplies on behalf of the customer. Account setup deliver completed account setup form. If you already have an account, you can login below and place your order. Please be aware that submission of this form is not a secure method of.
See other page for additional supplies or order online. All of the supplies provided can only be used for specimens that are returned for testing to irmc lab. Form 1945a client supply requisition patient information sheet other attach copy miscellaneous supplies. Client supply order form iu health pathology laboratory fax to 3174916020 350 west 11th street indianapolis, in 462024108 client name. The supplies provided by our company to you are solely to be used for the collection and preparation of specimens, which are being sent to our laboratory for testing. When doing supply inventory, check for tissue and pap supplies, contact pathology consultation services at 3210370 to request supply forms or check on the status of. Other list below submit your request to the fax below. Dynacare laboratories client supply order form client name. Please complete the form by entering the desired quantity of each supply. Laboratory supply order form supply order formnon uphs clinics, 1214, rev. It is not intended that these supplies be provided for any other uses. Download or print the aculabs supply order form pdf.
For requisition and printed items, please allow 57 business days for delivery of imprinted requisitions. Order and budget for office supplies with this printable request order. Acl laboratories client supply general request form page 2 of 2 fax request to. For routine supplies, fax form to 97052178 or send this form along with the courier and supplies will be delivered in a few days. You will receive an email confirmation that your order has been placed. For a complete listing of supplies available from sterling regional medical center laboratory, see supplies in general infor mation in the test catalog online. Client supply order form blood collection tubes transportation media pk100 t47 serum separator tube 7. Unless your order is requested sooner, please allow 72. Requisitions please call your order to client services 978 l 35444 7 ml dark blue tube with edta 7 ml dark blue tube with no edta yellow acd tube solution b laboratory forms clear specimen transport bag, m 100bag fax order to.
As a health care provider, how do i set up a labcorp account. Outpatient laboratory hours as of 092019 to contact cincinnati childrens main operator, please call. We can only supply enough items to equal the amount of work that is sent to an iu health laboratory. Formcliereq each client supply requisition requcyto05 each cytology requisition insturin24h each 24hr urine collection instruction label requhisto02 each histopathology requisition formretu each returned goods form dringluc50or1 bottle glucose challenge drink orange 50g dringluc75or1 bottle glucose tolerance drink orange 75g.
Lifelabs provides supplies and containers required for the collection of laboratory specimens referred to lifelabs. Supply orders may be adjusted based on the types and amounts of samples submitted to deaconess regional laboratory. Supply orders are filled based on client test volume and previous supply usage. Complete the following form to order drug testing supplies with your labcorp account number. Edward reference lab order supply form instructions for forms submission. Lab supply order request form account name date indiana regional medical center laboratory provides supplies that the client requires to collect specimens to be sent to irmc laboratory for analysis. These swabs are ordered directly through the qeiidivision of microbiology. Sometimes a company needs certain materials or products that they dont have, so what they can do is use these forms to request that they be purchased. A onesource laboratory provider for womens health testing. To order a supply of viromeds test request forms preprinted with client data, please contact account management.
Fill labcorp supply order form, download blank or editable online. To avoid delays andor missed deliveries please include your complete name and address when placing an order. Client supply general request form page 1 of 2 8473497575 il date. Edward reference lab order supply edwardelmhurst health.
Parkview health laboratories client supply requisition fax orders to. To prevent delays, please allow 5 to 7 business days for delivery. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly no software. If a different quantity is needed, please do not use this form. Client supply order form indiana university health. It is a violation of our compliance policy and the office of the.
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