Forms Online

Forms Online

Homepage Fill Out a Valid Order Quest Diagnostics Form
Structure

The Order Quest Diagnostics form serves as a crucial tool in the healthcare process, facilitating the collection and management of patient information for laboratory testing. This form captures essential details such as the patient's name, date of birth, sex, and ethnic origin, ensuring that the laboratory can accurately identify and categorize samples. It also requires the ordering physician's information, which is vital for communication and follow-up. The form includes sections for specifying the type of tests requested, such as biochemistry profiles, lipid profiles, and various other specialized tests, enabling healthcare providers to tailor diagnostics to the patient's needs. Additionally, it addresses logistical aspects, such as insurance details and payment responsibilities, while providing options for sending duplicate reports to other physicians. The form's design incorporates various fields for clinical details, sample types, and specific patient circumstances, such as pregnancy or hormone use, which may influence test results. By streamlining these processes, the Order Quest Diagnostics form enhances the efficiency of laboratory services and supports informed decision-making in patient care.

Common mistakes

  1. Incorrect Personal Information: Filling out the surname, forenames, or date of birth incorrectly can lead to significant delays in processing. Ensure that all personal details are accurate and match official identification.

  2. Missing Account Code: If the account code is not provided when required, it can result in complications with billing and insurance claims. Always check if an account code is necessary for your submission.

  3. Improper Selection of Sex: Selecting the wrong sex can affect test results and reporting. Make sure to select the correct option, whether it is male or female.

  4. Neglecting Ethnic Origin: Failing to indicate ethnic origin when required can lead to incomplete data for health assessments. This information is often crucial for accurate diagnosis and treatment.

  5. Omitting Clinical Details: Not providing specific clinical details can hinder the healthcare provider's ability to understand the context of the tests being ordered. Always include relevant clinical information.

  6. Incorrect Reporting of Fasting Status: If fasting is required, be sure to indicate this accurately. Incorrect information can affect test results and lead to the need for retesting.

  7. Failure to Provide Patient Address: If the patient is to receive an invoice, the address must be included. Omitting this information can delay billing and payment processes.

  8. Not Specifying Insurance Information: If insurance is to cover the fees, include all necessary insurance details. Missing this information can lead to unexpected out-of-pocket expenses.

  9. Improper Sample Type or Source: Selecting the wrong sample type or source can lead to inaccurate testing. Double-check that the sample type aligns with the test being ordered.

  10. Ignoring Additional Physician Information: If a duplicate report is needed or if another physician should receive the results, ensure their details are filled out correctly. This avoids confusion and ensures timely communication.

Preview - Order Quest Diagnostics Form

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Documents used along the form

The Order Quest Diagnostics form is a critical document used for requesting laboratory tests. Several other forms and documents often accompany it to ensure that all necessary information is collected and processed efficiently. Below is a list of these additional documents, each with a brief description.

  • Patient Registration Form: This form collects essential information about the patient, including contact details and insurance information, to establish a record with the healthcare provider.
  • Insurance Authorization Form: This document is used to obtain approval from the insurance company before specific tests or procedures are performed, ensuring coverage for the patient.
  • Motorcycle Bill of Sale: This form is essential for documenting the sale of a motorcycle in Texas, providing vital details that can be referenced later, including the motorcycle's condition and price, as well as ownership transfer, ensuring a legally binding agreement, such as the one found at autobillofsaleform.com/motorcycle-bill-of-sale-form/texas-motorcycle-bill-of-sale-form.
  • Consent Form: Patients may be required to sign this form to provide consent for specific tests or treatments, acknowledging their understanding of the procedures involved.
  • Lab Test Requisition Form: Similar to the Order Quest Diagnostics form, this requisition specifies the tests to be performed, along with any relevant clinical details provided by the ordering physician.
  • Billing Information Form: This form captures payment details, including who will be responsible for fees associated with the tests, whether it be the patient, insurance company, or another party.
  • Medical History Form: This document gathers comprehensive information about the patient’s past medical history, medications, and any relevant family health issues that may affect testing outcomes.
  • Sample Collection Guidelines: This guideline provides instructions on how to properly collect samples for testing, ensuring accuracy and reliability in lab results.
  • Test Results Release Form: Patients may need to fill out this form to authorize the release of their test results to third parties, such as other healthcare providers or family members.
  • Follow-Up Appointment Request: After receiving test results, patients may use this form to schedule follow-up appointments with their healthcare provider to discuss findings and next steps.

These documents work together to streamline the testing process and ensure that patients receive the care they need. Proper completion and submission of all forms help facilitate communication between patients, healthcare providers, and laboratories.

Similar forms

The Order Quest Diagnostics form shares similarities with the Patient Registration Form, commonly used in healthcare settings. Both documents gather essential patient information, including personal details such as name, date of birth, and contact information. The Patient Registration Form also often includes sections for insurance information and medical history, allowing healthcare providers to have a comprehensive understanding of the patient's background. This ensures that the provider can deliver appropriate care tailored to the patient's needs.

When dealing with workplace injuries, it's important to understand the various forms that facilitate communication and claims processing, such as the Georgia WC-14 form, which can be obtained online at https://georgiapdf.com/; this form is essential for notifying the Georgia State Board of Workers' Compensation and ensuring that all necessary information is submitted for a timely resolution of claims.

Another document that aligns closely with the Order Quest Diagnostics form is the Laboratory Requisition Form. Like the Quest form, this requisition form is used to request specific laboratory tests. It includes details about the patient, the ordering physician, and the tests required. Both forms emphasize the importance of accurate information to ensure proper identification and processing of samples, ultimately leading to reliable test results.

The Medical History Form is another document that bears resemblance to the Order Quest Diagnostics form. This form typically collects detailed information about a patient’s past medical history, medications, and allergies. While the Quest form focuses more on specific tests and results, both documents aim to compile relevant patient information that can inform healthcare decisions. Having access to this data helps healthcare providers assess risks and tailor treatment plans accordingly.

In addition, the Consent for Treatment Form is similar to the Order Quest Diagnostics form in that both documents require patient acknowledgment and agreement. The Consent for Treatment Form ensures that patients understand and agree to the procedures and tests being performed. Similarly, the Quest form often requires a patient’s signature or acknowledgment regarding the tests ordered, reinforcing the importance of informed consent in healthcare.

The Insurance Claim Form also shares characteristics with the Order Quest Diagnostics form. Both documents capture insurance details to facilitate billing and reimbursement processes. The Quest form includes sections for insurance information, while the Insurance Claim Form is specifically designed to submit claims to insurance companies for payment. Accurate completion of both forms is essential for ensuring that healthcare providers are compensated for their services.

The Referral Form is another document that parallels the Order Quest Diagnostics form. This form is used when a healthcare provider refers a patient to a specialist or for specific tests. Like the Quest form, it includes patient information and details about the tests or services needed. Both documents serve to streamline communication between providers, ensuring that patients receive appropriate care in a timely manner.

Finally, the Test Result Report is akin to the Order Quest Diagnostics form in that it provides critical information regarding a patient’s health status. While the Quest form is utilized to order tests, the Test Result Report summarizes the outcomes of those tests. Both documents are integral to the patient care process, as they ensure that healthcare providers have access to the necessary information to make informed decisions regarding treatment and follow-up care.

Dos and Don'ts

When filling out the Order Quest Diagnostics form, it's essential to be thorough and accurate. Here’s a list of things you should and shouldn't do to ensure a smooth process.

  • Do provide your full name and date of birth accurately.
  • Do indicate your sex and ethnic origin as required.
  • Do ensure that the ordering physician's details are correctly filled out.
  • Do specify if you are fasting or pregnant, as this information is crucial for accurate test results.
  • Do include your insurance information if applicable, and specify who will be responsible for the fees.
  • Don't leave any sections blank unless instructed; incomplete forms can delay processing.
  • Don't forget to provide the patient’s address if an invoice will be sent.
  • Don't use abbreviations or shorthand that may confuse the laboratory staff.
  • Don't submit the form without double-checking all entries for accuracy.

Key takeaways

  • Ensure all personal details are accurately filled out, including surname, date of birth, and sex.

  • Specify the ordering physician and provide their contact details for effective communication.

  • Indicate the insurance information if applicable, including the insurance reference and the party responsible for payment.

  • Clearly mark the clinical details and tests required, selecting from the provided list to avoid any confusion.

  • Include the date and time the sample is collected, as this information is crucial for accurate processing.

  • Double-check that the patient's address is complete if an invoice is to be sent, ensuring all necessary address lines are filled out.

How to Use Order Quest Diagnostics

After you complete the Order Quest Diagnostics form, it will be sent to the lab for processing. Make sure all information is accurate to avoid any delays. Follow the steps below to fill out the form correctly.

  1. Write your surname at the top of the form.
  2. Fill in the account code if you have one; otherwise, leave it blank.
  3. Enter the name of the ordering physician.
  4. Provide your forenames, date of birth, and select your sex.
  5. Indicate your ethnic origin.
  6. Fill in your office/patient number.
  7. Mark whether you are fasting and if you are pregnant.
  8. If there is an additional physician, include their name.
  9. Write the physician's address if no account code is provided.
  10. Choose your patient title (Mr, Mrs, Dr, etc.).
  11. Record the date collected and time collected using the 24-hour clock format.
  12. Specify who will pay the fees: doctor, patient, insurance company, or other.
  13. If applicable, enter the insurance reference.
  14. Fill out your patient address if you are receiving an invoice.
  15. Provide clinical details by selecting the appropriate tests from the list.
  16. Indicate the sample type and source.
  17. State the reason for smear and provide the LMP (last menstrual period) date.
  18. List any last test information and answer if you are pregnant, have an IUCD fitted, are post-natal, or taking hormones.
  19. Leave the office use only section blank.