Order Quest Diagnostics Form

Order Quest Diagnostics Form

The Order Quest Diagnostics form is a document used to request various medical tests and laboratory analyses. It captures essential information about the patient, such as their personal details, insurance information, and the specific tests ordered. This form ensures that healthcare providers can efficiently process and manage laboratory requests, facilitating accurate and timely patient care.

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The Order Quest Diagnostics form is an essential document for healthcare providers and patients alike, facilitating the collection and processing of medical tests. This form captures vital information, including patient details such as surname, date of birth, and sex, which are crucial for accurate identification and reporting. It also includes sections for the ordering physician's information, ensuring that results are directed to the appropriate healthcare professional. Patients may find fields concerning their ethnic origin, fasting status, and whether they are pregnant particularly relevant, as these factors can influence test results. Furthermore, the form allows for the inclusion of insurance details, which helps streamline billing processes. Various clinical tests can be requested, ranging from comprehensive profiles to specific tests like lipid or thyroid profiles, each identified by unique codes. Additional options for sending duplicate reports and specifying sample types further enhance the form's utility. Overall, the Order Quest Diagnostics form is designed to simplify the testing process while ensuring that all necessary information is collected efficiently.

Common Questions

What is the Order Quest Diagnostics form used for?

The Order Quest Diagnostics form is used by healthcare providers to request laboratory tests for patients. It collects essential patient information and specifies the tests needed, ensuring that the laboratory has all the necessary details to process the order accurately.

What information do I need to fill out on the form?

You will need to provide the patient's surname, forenames, date of birth, sex, ethnic origin, and contact details. Additionally, include the ordering physician's information, the account code (if applicable), and any specific clinical details related to the tests being requested.

Is fasting required before testing?

Fasting may be required for certain tests. The form includes a section to indicate whether the patient is fasting. It is important to follow the specific instructions provided by the healthcare provider regarding fasting to ensure accurate test results.

Can I send a duplicate report to another physician?

Yes, you can request a duplicate report copy to be sent to an additional physician. Just fill out the section for the additional physician’s address on the form to ensure they receive the necessary information.

What should I do if I don’t have an account code?

If you do not have an account code, you must provide the physician's address on the form. This information is required to process the order and ensure that the results are sent to the correct location.

Who is responsible for paying the fees?

The form includes a section to indicate who will be responsible for the fees. Options include the doctor, the patient, or an insurance company. Select the appropriate option based on your situation to avoid billing issues later.

What types of tests can be ordered using this form?

The form allows for a variety of tests, including biochemistry profiles, lipid profiles, thyroid profiles, and more. Each test type is listed with its corresponding code, making it easy to specify the required tests for the patient.

How should I provide the patient's address?

When the patient is receiving an invoice, you should fill out the patient’s address on the form. Include all relevant address lines to ensure that the invoice reaches the patient without delays.

What if the patient is pregnant or has other specific conditions?

The form includes sections to indicate if the patient is pregnant, has an IUCD fitted, or is taking hormones. These details are important for the laboratory to consider when processing the tests and interpreting the results.

What happens after I submit the form?

Once the form is completed and submitted, the laboratory will process the order based on the provided information. Test results will be generated and sent to the designated physician or address as indicated on the form.

Key takeaways

When filling out and using the Order Quest Diagnostics form, keep the following key points in mind:

  1. Accurate Information: Ensure that all personal details, such as surname, date of birth, and sex, are filled out correctly.
  2. Account Code: If you have an account code, include it. If not, provide the physician's address.
  3. Ordering Physician: Clearly indicate the name of the ordering physician to avoid any confusion.
  4. Fasting Requirements: Note if fasting is required for the tests. This is crucial for accurate results.
  5. Insurance Information: Fill out the insurance reference and specify who will pay for the fees: doctor, patient, or insurance company.
  6. Clinical Details: Select the appropriate tests needed, such as biochemistry or immunology profiles.
  7. Patient Address: Provide the patient's address only if an invoice will be sent to them.
  8. Sample Type: Specify the sample type and source to ensure proper handling and testing.
  9. Pregnancy Status: Indicate if the patient is pregnant or taking hormones, as this can affect test results.
  10. Review Before Submission: Double-check all entries for accuracy before submitting the form to avoid delays in processing.

Completing the form accurately helps ensure timely and precise testing. Your attention to detail is appreciated and essential for effective healthcare.

Form Properties

Fact Name Details
Provider Name Quest Diagnostics
Provider Address 10 Upper Wimpole Street, London, W1G 6LL
Account Code Provided by Quest Diagnostics
Ordering Physician Details of the physician ordering the tests must be included.
Patient Information Includes surname, forenames, date of birth, sex, and ethnic origin.
Fasting Requirement Indicates whether the patient needs to fast before the tests.
Insurance Reference Required if fees are to be covered by an insurance company.
Clinical Details Options for various tests, including biochemistry and immunology profiles.
Sample Type Specifies the type of sample required for testing, such as blood or urine.

Misconceptions

  • Misconception 1: The Order Quest Diagnostics form is only for specific types of tests.
  • This is not true. The form is designed to accommodate a wide range of tests, including biochemistry, hematology, and immunology profiles. Patients can select from various tests based on their medical needs.

  • Misconception 2: Only physicians can fill out the Order Quest Diagnostics form.
  • While it is common for physicians to complete the form, patients can also provide necessary information. This includes their personal details and any specific requests related to their health. Collaboration between patients and healthcare providers is encouraged.

  • Misconception 3: The form must be filled out in a specific way to be accepted.
  • Although accuracy is important, the form allows for some flexibility. As long as all required fields are completed, and the information is clear, the form can be processed. It’s advisable to double-check for any missing information to avoid delays.

  • Misconception 4: Submitting the form guarantees immediate test results.
  • This is a common misunderstanding. The processing time for test results can vary based on the type of tests ordered and the laboratory’s workload. Patients should ask their healthcare provider for an estimated timeline for when they can expect results.

Order Quest Diagnostics Preview

Surname:

Quest Diagnostics

10 Upper Wimpole Street

London, W1G 6LL

Account Code:

provided by Quest Diagnostics

Ordering Physician:

Forenames:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

 

 

 

 

Sex:

 

 

 

 

 

 

 

day

month

year

 

 

 

Male

Female

Ethnic Origin:

 

Office / Patient number:

 

Fasting:

 

Pregnant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Physician:

Send duplicate report copy to:

Physician's Address: Required if no account code indicated

Address Line # 1

Patient's title:

Mr / Mrs / Dr / Prof / etc

Date collected:

day month year

Time collected: (24 hour clock)

hour minute

Fees to be paid by:

 

 

Doctor

Patient

 

Insurance Company

Other

 

 

details below

INSURANCE REFERENCE

Address Line # 2

Address Line # 3

Address Line # 4

Reports by:

Telephone: code number

Facsimile: code number

Patient Address: only required if patient is receiving invoice

Address Line # 1

Address Line # 2

Address Line # 3

Address Line # 4

Clinical Details:

Short Biochemistry

(QDL1)

Comprehensive Profile

(QDL5)

Lipid Profile

(QDL9)

SST

 

SST, Lavender, ESR

 

SST

 

Full Biochemistry

 

 

 

(QDL2)

Haematology Profile

(QDL6)

Hepatic Profile

(QDL10)

SST

 

 

 

 

 

 

Short Biochemistry

 

Lavender, ESR

 

SST

 

 

 

 

 

 

plus Haematology

(QDL3)

Thyroid Profile 1

(QDL7)

Immunology Profile

(QDL11)

SST, Lavender, ESR

 

SST

 

ESR, Lavender, SST

 

 

 

 

 

Full Biochemistry

 

Thyroid Profile 2

(QDL8)

MSU Profile

(QDL12)

plus Haematology

 

(QDL4)

SST

 

Mid Stream Urine

 

SST, Lavender, ESR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRM.UWS.2401.H07.3

FBC

 

 

(Lav)

Coagulation

 

(Light Blue)

PT & APTT

 

 

 

ertert

 

 

 

U & E

 

 

(SST)

Cardiac Enzyme

 

 

(SST)

Autoantibodies

 

 

(SST)

PSA

 

 

(SST)

PSA, free PSA ratio

 

(SST)

HIV screen

 

 

(SST)

Hepatitis B surface Ag

(SST)

Hepatitis B immunity

 

(SST)

ThinPrep

(ThinPrep Vial)

Pap smear

 

 

(Slide)

 

 

 

 

Other Tests:

Sample Type:

Source:

 

 

 

 

 

 

 

 

 

 

Reason for Smear:

 

 

 

LMP (1st DAY):

 

LAST TEST:

 

 

Pregnant: Y / N

IUCD Fitted: Y / N

Post Natal: Y / N

Taking Hormones: Y / N

 

 

 

 

 

 

 

 

 

 

Office use only - do not write here

 

 

 

 

 

 

 

 

70002 RF02050/1

FOR LAB USE ONLY

 

 

RECEIPT OF SPECIMEN

 

OTHERS

 

 

 

 

 

 

 

 

EDTA

SST

GREY

MSU

TIME IN (R)

TIME IN PHL

TIME OUT PHL

 

 

 

 

 

 

 

 

 

 

 

 

 

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Common mistakes

  1. Incomplete Personal Information: Failing to provide all required personal details can lead to delays. Ensure that the surname, forenames, date of birth, and sex are filled out completely. Missing any of this information can hinder the processing of your order.

  2. Incorrect Physician Information: It is crucial to accurately list the ordering physician's name and address. If the physician's details are incorrect or missing, it may cause issues with report delivery and communication.

  3. Insurance Information Errors: Providing incorrect insurance details can result in billing complications. Double-check the insurance reference and ensure the appropriate fees payer is selected. If you are using insurance, include all necessary information for proper processing.

  4. Neglecting to Indicate Fasting or Pregnancy Status: Not marking whether the patient is fasting or pregnant can affect test results. It is important to answer these questions accurately to ensure the tests are conducted correctly.

Dos and Don'ts

When filling out the Order Quest Diagnostics form, it's essential to ensure accuracy and completeness. Here are some important do's and don'ts to keep in mind:

  • Do provide your full surname and forenames clearly.
  • Do include the correct date of birth in the specified format.
  • Do indicate your sex accurately to avoid any confusion.
  • Do fill in the account code if one has been provided by Quest Diagnostics.
  • Don't leave any required fields blank; incomplete forms can delay processing.
  • Don't forget to specify whether you are fasting, as this may impact test results.
  • Don't use abbreviations for addresses; write them out fully to ensure clarity.
  • Don't neglect to sign and date the form where indicated, as this confirms your consent.

Similar forms

The Patient Information Form is similar to the Order Quest Diagnostics form in that it collects essential personal details about the patient. This document includes the patient's name, date of birth, and contact information. Like the Order form, it often requires the patient to indicate their insurance details and the name of their primary physician. Both forms aim to ensure that the healthcare provider has accurate information for billing and communication purposes.

The Laboratory Requisition Form serves a similar purpose as the Order Quest Diagnostics form. It is used to request specific laboratory tests for patients. This document typically includes sections for the ordering physician's information, patient demographics, and a list of tests to be performed. Just like the Order form, it helps streamline the process of collecting and analyzing patient samples.

The Medical History Form is another document that shares similarities with the Order Quest Diagnostics form. It gathers comprehensive information about a patient's medical background, including previous illnesses, surgeries, and current medications. This information is vital for healthcare providers to make informed decisions about the patient's care, much like how the Order form aids in determining the appropriate tests needed.

In addition to the various medical forms discussed, it is also essential for boat owners to understand the importance of documentation in transferring ownership of vessels. A New York Boat Bill of Sale form is a legal document that records the transfer of ownership of a boat from one party to another. This form serves as proof of the sale and includes important details about the vessel and the parties involved. Understanding its components can help ensure a smooth transaction and protect both the buyer and the seller. For further information, you can refer to the Vessel Bill of Sale.

The Consent Form is crucial in healthcare, similar to the Order Quest Diagnostics form. It ensures that patients understand and agree to the tests and procedures being performed. This document often requires a signature, indicating that the patient is informed about the implications of the tests, just as the Order form ensures that the patient is aware of the testing process.

The Insurance Claim Form is another document that relates closely to the Order Quest Diagnostics form. It is used to request payment from an insurance company for medical services rendered. Both forms require detailed patient information and specifics about the services provided, ensuring that the billing process is accurate and efficient.

The Referral Form is similar to the Order Quest Diagnostics form in that it facilitates communication between healthcare providers. It typically includes the referring physician's information, the patient's details, and the reason for the referral. This document ensures that all necessary information is passed along, much like how the Order form conveys essential details for lab tests.

The Prescription Pad can also be compared to the Order Quest Diagnostics form. It is used by healthcare providers to prescribe medications or tests for patients. Both documents require the physician's details and patient information, ensuring that the instructions are clear and that the patient receives the correct treatment or testing.

The Encounter Form is similar to the Order Quest Diagnostics form as it records the details of a patient's visit to a healthcare provider. This form includes information about the services provided and any tests ordered during the visit. Both forms aim to document patient care accurately, facilitating better communication and billing.

The Test Result Report shares similarities with the Order Quest Diagnostics form in that it provides critical information about a patient's lab results. This document summarizes the findings from the tests ordered and is often sent to the ordering physician and the patient. Both forms are integral to the patient care process, ensuring that results are communicated effectively.

Lastly, the Follow-Up Appointment Form is akin to the Order Quest Diagnostics form in that it schedules future visits for patients based on their test results or ongoing treatment needs. It includes patient details and the purpose of the follow-up, ensuring continuity of care, much like the Order form ensures that necessary tests are completed and analyzed.