Vitalant Specialty Laboratories & Therapeutics
Coagulation Lab
About Us
Laboratory Information
Services
Tests
Specimen Collection Procedures
Test Request Instructions
Pathways
Forms
Resources
Anticoagulation Monitoring
Pathways - More Information
Education
Coagulation Updates
Transfusion Medicine Updates
News
Licenses & Accreditations
FAQ
Contact Us
Clinical Apheresis
About Us
Services
Regulatory Information
Resources
Education
FAQ
Contact Us
Hemostasis Thrombosis Clinic
About Us
FAQ
Forms
Contact Us
Coagulation Lab
About Us
Laboratory Information
Services
Tests
Specimen Collection Procedures
Test Request Instructions
Pathways
Forms
Resources
Resources
Anticoagulation Monitoring
Pathways - More Information
Education
Education
Coagulation Updates
Transfusion Medicine Updates
News
Licenses & Accreditations
FAQ
Contact Us
Clinical Apheresis
About Us
Services
Regulatory Information
Resources
Education
FAQ
Contact Us
Hemostasis Thrombosis Clinic
About Us
FAQ
Forms
Contact Us
Please
click here
to view our hours of operation for the upcoming July 4th holiday.
Please
click here
for information on testing for COVID-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT).
Test Request Instructions
Instructions for Completing the Coagulation Laboratory Test Requisition Form
Complete a separate
Test Requisition
for each patient.
Please use a pen to complete the form. Be sure to PRINT legibly.
Record the Following
Your client account number or hospital name/address if not already there.
Patient name, patient ID (not SSN), date of birth, sex, lab ID number
Collection date/time
Ordering physician name
Complete medication history area (if applicable). It is especially important to note any COUMADIN, HEPARIN, or direct thrombin inhibitors (such as Lepirudin or Argatroban) in use.
Mark box(es) with an
X or checkmark
indicating the tests requested.
If you wish to decline automatic reflexing of a test, you must mark the box provided for this purpose.
If requesting the Heparin Level/anti Xa Assay, mark the type of heparin the patient is receiving. This information MUST be provided; otherwise the laboratory will run the assay as if the patient is receiving unfractionated heparin.
Write the required patient information on the specimen container.
Refer to Specimen Labeling Policy
.
Keep a copy of the requisition for your records.
Fold a copy of the requisition with the patient information facing out.
Place the labeled specimen(s) in the ziplock portion of the specimen bag. Place the folded test requisition into the outside pocket of the specimen bag.
If multiple transport temperatures are required, place specimen(s) in separate bags.
Refer to the Shipping/Packing Instructions
.