Test Requisitions
To request printed test requisitions, please contact an Labcorp Oncology representative:
Brentwood/Phoenix Clients call 866-875-2271
Shelton/New York Clients call 800-447-5816
The following test requisition forms have fillable fields, so you can download, save your client information and just add the patient information and test request(s).
- Hematology/Oncology (PDF) - Brentwood/Phoenix Clients Only
- Hematology/Oncology (PDF) - Shelton/NY Clients Only
- Hematopathology (PDF) - Brentwood/Phoenix Clients Only
- Hematopathology (PDF) - Shelton/New York Clients Only
- Gene Profiling Assays (PDF)
- Hereditary Cancer (PDF)
- Immunohistochemistry (PDF)
- Prognostic Therapeutic (PDF)
- Solid Tumor Pathology (PDF)
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).