Unequivocal traceability of the patient to the request and sample
Name, Age, Gender, MRD Number,
Identity and contact information of requester
Name or Signature of requester
Ward / OPD
Identification of the examination(s) requested
Informed clinical and technical advice, and clinical interpretation can be provided.
Name & identification of Laboratory & Section of laboratory
Type of sample, Site of collection if required for specific examination
Sample collection date & time
Write all the examinations performed by the laboratory.
If necessary make different requisition forms for routine & special investigations.
If a laboratory is performing any examination by different method or instruments, mention both method or instrument in requisition form so that users can select the required method or instrument.