4.2 Requisition Review, Order Clarification & Documentation

4.2 Requisition Review, Order Clarification & Documentation

Elements of the Laboratory Test Requisition

A laboratory requisition is a formal medical and legal document requesting diagnostic testing. It may be transmitted electronically via an Electronic Health Record (EHR) / Computerized Physician Order Entry (CPOE) system or provided as a paper manifest.

Mandatory Requisition Components

+--------------------------------------------------------------------------+
|                       CLINICAL LABORATORY REQUISITION                    |
+--------------------------------------------------------------------------+
| Patient Name: DOE, JANE ELIZABETH               DOB: 04/14/1988          |
| MRN: 9876543210        Gender: F                Accession #: AC26-08914  |
| Ordering Physician: Dr. Robert Vance, MD        NPI: 1234567890          |
| Location: Inpatient 4-East / Bed 412A           Order Date: 2026-08-27   |
| ICD-10 Code: E11.9 (Type 2 Diabetes Mellitus)   Status: Fasting (10 hr)  |
+--------------------------------------------------------------------------+
| Tests Ordered:                                                           |
|  [X] 80061 - Lipid Panel (SST Gold / Serum Separator)                    |
|  [X] 82947 - Glucose, Quantitative (Sodium Fluoride Gray Top)            |
|  [X] 83036 - Hemoglobin A1c (K2-EDTA Lavender Top)                       |
+--------------------------------------------------------------------------+
| Priority: ROUTINE [X]  TIMED [ ]  STAT [ ]  Collection: 07:00 AM         |
| Phlebotomist ID: PT-4882 (Initials: RC)        Drawn Date/Time: ________ |
+--------------------------------------------------------------------------+

1. Patient Demographic Data: Full legal name, date of birth, biological sex, and residential/billing address.
2. Identification Numbers: Hospital Medical Record Number (MRN), billing account number, or Social Security Number (where applicable).
3. Ordering Provider Information: Full name of ordering physician, physician assistant, or nurse practitioner, plus National Provider Identifier (NPI) and contact number for critical value notification.
4. Diagnostic Test Codes & Descriptions: Specific tests requested, corresponding CPT (Current Procedural Terminology) codes, and tube requirements.
5. Clinical Indication / ICD-10 Diagnosis Codes: Medical necessity justification required for laboratory processing and insurance billing.
6. Test Priority & Timing: STAT (immediate emergency), Timed (exact collection time, e.g., TDM, GTT), ASAP (within 30-60 minutes), or Routine.
7. Patient Pre-Collection Status: Explicit documentation of fasting hours, basal state, diet compliance, or special infusion status.
8. Collection Metadata Fields: Date of collection, exact military time of draw, specimen source/type, and phlebotomist's identification code or signature.

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Accessioning Numbers and Barcode Specimen Tracking

When a test requisition is entered into the Laboratory Information System (LIS), the software automatically assigns a unique alphanumeric identifier known as an accession number.

• Unique Specimen Tracking: The accession number identifies that specific collection event across all pre-analytical, analytical, and post-analytical phases.
• Barcode Integrity: LIS-generated barcodes encode the accession number, patient MRN, tests ordered, tube type, and additive.
• Point-of-Care Scanning: Modern bedside scanning systems require the phlebotomist to scan the patient's wristband barcode, followed by scanning each collection tube barcode immediately at the bedside after the blood is drawn. Scanning before venipuncture or pre-printing labels outside the patient's presence is a major regulatory violation.
• Zero-Tolerance Relabeling Policy: If a tube label is damaged, unreadable, or applied incorrectly, laboratory accreditation bodies (CLSI, CAP) prohibit relabeling or transferring specimens between tubes. The specimen must be rejected and redrawn to guarantee patient safety.

Reviewing and Clarifying the Order Before You Draw

The Detailed Test Plan lists "review and clarify orders for patient specimen collection" as its own task. Reading the requisition at the bedside — after the patient has already been positioned and the tourniquet applied — is too late to discover that the test requires a fasting patient, a chilled tube, or a timing interval.

Build a fixed pre-draw review habit:

1. Confirm the test list and match it to tubes. Count the tubes you need before you enter. A requisition for a CBC, a comprehensive metabolic panel, and a PT/INR means lavender, gold or green, and light blue — and the light blue must be drawn before the lavender.
2. Look for special conditions. Fasting, timed draws, chilled transport, light protection, and site restrictions are all attached to the order.
3. Check for duplicate or conflicting orders. Two identical CBCs ordered an hour apart may be a duplicate-entry error or a legitimate serial monitoring order. Ask.
4. Verify test-to-container compatibility. A microbiology culture on a chemistry requisition, or a trace-element order without a royal blue tube available, must be resolved before collection.

[!WARNING] A phlebotomist never adds, deletes, or changes a test order. If a nurse asks you to "just add a magnesium while you're in there," the answer is that the provider must enter the order. Adding an unordered test is both a billing-compliance problem and a scope-of-practice violation. Equally, never cancel a test because you believe it is clinically unnecessary — that judgment is outside your scope.

Illegible, Incomplete, and Verbal Orders

An illegible handwritten requisition is resolved with the ordering provider, not by guessing from context. Verbal or telephone orders taken in urgent situations must be documented and later authenticated by the provider according to facility policy; a phlebotomist should not be the one accepting a verbal order for a test.

Documenting Patient and Collection Information

The final DTP task in patient and site preparation is documentation. A specimen with a perfect draw and no documentation is still a defective specimen, because the laboratory cannot defend the result.

The accession number ties these together. When a laboratory information system assigns an accession number, it becomes the single key that links the order, the labels, the specimen, the aliquots, and the released result — which is why writing a result under the wrong accession is functionally identical to mislabeling the tube.

[!IMPORTANT] Document the draw time you actually drew, not the time you were scheduled to draw. For a peak drug level or a two-hour post-prandial glucose, the recorded time is what the physician uses to interpret the number. A convenient rounding of 09:00 for a draw performed at 09:22 can make a therapeutic drug level look toxic or subtherapeutic.

When the Draw Does Not Happen

If a patient is unavailable, refuses, or the draw is unsuccessful, that is documented too — with the reason, the time, and who was notified. An undrawn STAT specimen that no one was told about is a patient-safety event, not a paperwork gap.