Lab Orders
Lab Order Form
Order Number:
Status:
Chart No:
Patient Charts:
--Select--
Patient Name:
Client Number:
Date of Birth:
Age:
Gender:
--Select--
Male
Female
Not Stated
Street Address:
City:
State:
Zip Code:
Physician:
Phone Number:
Bill To:
--Select--
Patient
Client
Medicare
Medi-Caid
Medi-Medi
Other Insurance
Second Insurance
Consolidated Bill
HMO
Unknown
Date Collected:
Time Collected:
Diagnosis Coding:
Message To Laboratory:
Fasting:
--Select--
Yes
No
Handling:
--Select--
Routine
STAT
ASAP
Call Results
Fax Results
Add Test:
Check
Test Dictionary:
--Select--
Test Code
Test Name
Print
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