Submission of requests for laboratory testing should be accompanied by the Clinical Lab Request Form. Laboratory procedures are performed ONLY upon a physician’s written request. Each requisition form for laboratory services must clearly identify:

Patient name, sex, birth date, include unique I.D. number, lab reference number.

Collection date and time

Diagnosis Code (ICD10)

Type of specimen submitted, indicate serial and timed collection

Patient fasting conditions (if applicable)

Interval and total volume if a timed urine collection

Source of specimen and/or other comments in “comments” box

Authorization for laboratory work, include the name of the ordering physician and UPIN in addition to the name and address of the facility to which the results will be sent.

Check test(s) requested. If the Department of Laboratory Medicine offers a procedure that does not appear on the request form, print plainly the full name of the test desired in the space marked “OTHER REQUESTS”.

Directions

Complete a separate Clinical Lab Request form for each patient. Please provide all information on the left hand side of the request form. Fold completed request form and place in the outside pocket of the Specimen Bag. If submitting more than one specimen per patient, and specimens need to be stored and transported at different temperatures, use separate bags and Lab Request forms for each temperature type. Special requests for testing should be noted on the requisition.

If you are from a clinical facility outside the UW Medicine system and have specific questions about laboratory specimens call Reference Laboratory Services at:

Monday – Friday 7:00 AM – 11:00 PM, Saturday 8:00 AM – 3:30 PM (PST)

Tel: (206) 520-4600 or 1 (800) 713-5198

Fax: (206) 520-4903

Email: commserv@u.washington.edu

(All email will be answered within 24 hours, M-F)

After hours, weekends & holidays:

(206) 598-6190 – UWMC paging operator (request the Laboratory Medicine resident on-call)

(206) 598-6224 – Clinical Laboratory