New Hematology Genetics Requisition Form
NEW: Versiti’s Hematology Genetics Lab has implemented a new order requisition form. Learn more.
New Hemostasis Requisition Form
A new order requisition form is now available for Versiti’s Hemostasis Lab.
Please include a completed requisition with each patient sample referred to the Diagnostic Laboratories. You may print a blank requisition by selecting it below. Requisitions preprinted with your name, address and client number are available from Client Services.
Please note, if RNA or DNA samples are being sent, isolation of nucleic acids for clinical testing MUST occur in a CLIA-certified laboratory or a laboratory meeting equivalent requirements as determined by the CAP and/or the CMS. Additional specimen requirements can be found on the individual test requisitions or in our online test catalog
- Informed Consent
- Medicare Beneficiary Form
- Patient Billing Form
- Patient Insurance Information Form-TRICARE
For IRL forms please visit the Immunohematology Reference Lab page.