Requisition and Labeling Instructions

Requisitions

Nationwide Children’s Laboratory Services will provide a test requisition to clients for specimen referral and patient referral.

The test requisition combines patient registration information, billing information, specimen information, barcoded specimen labels and a provider order for confirmation of testing. The patient bill requisition should be completed by the provider or authorized staff and signed by the ordering provider.

Please assure accuracy and legibility of all patient information. Please see Test Requisition Example below for details on how to fill out a requisition. Questions or concerns regarding completion of requisitions can be directed to Nationwide Children’s Laboratory Services at (614) 722-5477 or (800) 934-6575.

Test Requisitions

View a sample Test Requisition.

Additional Requisition Information

Client Requisitions - Please request requisitions through the Supply Ordering Form or contact Nationwide Children’s Laboratory Services at (614) 722-5477 or (800) 934-6575.

Non-Client Requisitions

For Anatomic Pathology Consult Requisition Form, click here.

For Diagnostic Immunology Testing Requisition Form, click here.

For DNA Repair Assessment (DDRFL) Patient Information Form, click here. 

For the Genetic Test Requisition Form click here.

For Hematology Flow Cytometry Requisition click here.

For Metabolic Test Requisition Form click here.

For the Oncology Genetic Requisition Form, click here.

Patient Consent Forms

Depending on the type of testing that is being done, a specific consent form may be required. For more information about consent forms, please contact Laboratory Services at (614) 722-5477 or (800) 934-6575 or at Laboratoryservices@Nationwidechildrens.org.

Standard Labeling Procedure

Positive patient identification and accurate specimen labeling is essential for reliable specimen analysis and reporting. The specimen label must contain a primary and secondary identifier.

Standard Label Requirements include the following information on the specimen label:

  1. Primary Identifier and Patient Name – Full first and last legal name (no nicknames or abbreviations)
  2. Secondary Identifier – Requisition or ChildLink™ barcode number, medical record number, Date of Birth or other unique identifier.
  3. Date and Time of Collection
  4. Name of Collector
  5. Specimen Source as described in Test Directory

Improperly Labeled Specimens

Specimens may be considered unacceptable for analysis if:

  • The specimen label contains incomplete or incorrect patient identifiers.
  • Unlabeled specimen(s). A label must be affixed to every specimen.

Notification of unacceptable specimens will be made by Nationwide Children’s Laboratory Services to the client. Written documentation of the event will be included on the patient report.

Specimen and Patient Referral 

Test samples can be referred to Nationwide Children's Laboratory Services or patients can be sent our Laboratory Service Centers for sample collection and submission.

Patient Referrals for Collections

Patients referred to any of our Laboratory Service Centers should proceed to registration and present the written provider order for laboratory testing. In some cases, such as genetic testing, a consent form may be required. A laboratory test order is required (i.e., paper requisition, electronic medical record, ChildLinkTM provider).

The laboratory test request must provide the following information:

  • Ordering provider's full name, address, phone number, and provider signature

  • Patient’s name and date of birth

  • Test(s) requested

  • Diagnosis and/or ICD-10 Codes

  • Date and time of order