HealthLab Outpatient Services
HealthLab offers a full range of clinical laboratory tests, specimen collection, consultative and courier services at several immediate care facilities and extended care facilities in the Chicagoland area. Learn about our comprehensive outpatient lab services here.
Please use the HealthLab standard requisition form to ensure the correct tests are performed and important billing information is provided. This completed form should accompany all specimens referred to HealthLab.
Completing the Front of the HealthLab Requisition Form:
Patient Information Section – Complete in full
- Print the patient’s name legibly (last name, first name, middle initial) and gender. Some situations may require the patient’s identity to be withheld from HealthLab (see “ID and Labeling” procedure, page 14). An alternative ID may be used if the office that assigns the alternate ID maintains appropriate records and the tests are billed to your account. The specimen ID and the requisition must match.
- Provide the patient’s birth date, phone number and social security number.
- Check the box next to the physician’s name. If no name is preprinted, write the physician’s full name and phone number in the box.
- A physician’s signature is required for all orders collected at a CDH office.
- Write date/time/initials of the person obtaining the specimen if the specimen is coming to the lab from your location.
- If federal reimbursement will be sought for ordered services, physicians must comply with Medicare requirements for medical necessity. Please attach a signed copy of an ABN if needed.
- If you would like a copy of the results to be faxed or mailed to another physician, please complete this area in full.
Billing Information Section – Use only if the charges are not to be billed to your account
- Indicate the patient’s relationship to the insured and the responsible party (if different from the patient). Complete the address section.
- Check the type of billing desired and complete the section in full (insurance, IDPA or patient bill).
- If the patient has Medicare, please complete the Medicare section in full.
- Enter the full diagnosis for which the patient is being tested, as well as any related history of illness for each test ordered. Be sure to code according to symptoms, not expected findings. Once the diagnosis for each test is completed, place the number corresponding to the diagnosis in the “Dx” column found in the test selection area.
Test Ordering Section
- For tests to be billed to your account, place a check in the “Dx” column for each test requested.
- For tests charged by HealthLab directly to the patient, insurance, IDPA or Medicare, place a check in the “Dx” column for each test requested and provide the number that corresponds to the diagnosis description.
The test selection area lists tests for organ or disease panels developed by the American Medical Association (AMA), as well as other frequently ordered tests. The test components of the AMA panels are listed on the back of the test requisition.
Completing the Back of the HealthLab Requisition Form:
For human immunodeficiency virus (HIV) testing, a signed consent form must accompany the specimen for all non-client billing (Medicare, IDPA and private insurance). This consent form is provided on the backside of the top (white) copy of all HealthLab test requisitions.
This section of the requisition lists the individual test components of each of the organ panels, disease panels and test combinations listed on the front of the form. It also shows the names of the test and the Current Procedural Terminology (CPT) code.
Extended Care Facility Services
HealthLab provides a complete array of clinical laboratory, phlebotomy, consultative education and courier services to extended care facilities. Please contact your HealthLab marketing representative at 630.864.8820 for detailed information about these services.
Outpatient/Immediate Care Facilities
Upon request, recurring/standing orders can be established for patients drawn at the outpatient lab or Immediate Care facilities. These orders are active for twelve months/one year at a time, after which they must be resubmitted. Orders can be faxed to the centralized scheduling department at 630.933.2607. Questions can be called in by phone to 630.933.5000.