Blood test lab request form: Free template and required fields

Key Takeaways

A blood test lab request form (also called a laboratory requisition form, lab requisition, or lab slip) is a standardized document that links patient demographics, ordered tests, and clinical context directly to laboratory processing and billing.

Required fields include patient name, DOB, MRN, ordering provider NPI (US), specimen type, collection date and time, test panel selection, and ICD-10 diagnosis codes for insurance reimbursement.

Field requirements vary by country: the US needs an NPI and ICD-10 codes, the UK uses the NHS number and GP referral codes, Australia requires MBS item numbers, and the UAE requires a DHA provider licence number.

You can download our free printable PDF template below, or let practice management software like Pabau auto-populate patient and provider details so the form fills itself and cuts transcription errors.

Download your free blood test lab request form

A blood test lab request form is the bridge between your practice and the laboratory. This standardized document, also called a laboratory requisition form or lab slip, captures patient information, communicates which tests you need, explains the clinical reason, and makes sure specimens are processed accurately and billed correctly.

Without a structured form, orders get lost, results are delayed, and insurance claims get rejected. Grab the free template above, then use the sections below to complete it correctly for your country and specialty.

What is a blood test lab request form?

A blood test lab request form is a standardized document a provider sends to a laboratory to order blood work for a specific patient.

The terms shift by region and lab – you will see the same document called a laboratory requisition form, a lab requisition, a blood test requisition, a requisition for blood work, or simply a lab slip – but they all describe the same thing. It serves three connected purposes:

• Patient identification: Full name, date of birth, medical record number (MRN), and contact details let the laboratory match results to the right patient – critical for HIPAA compliance and patient safety.
• Test ordering: Checkboxes or dropdown menus let you specify exactly which tests you need (CBC, comprehensive metabolic panel, lipid panel, or specialty panels) without ambiguity.
• Clinical context: Space for diagnosis codes (ICD-10) and a brief clinical reason explains why you are ordering the tests. This information affects insurance approval and helps lab technicians flag unusual results.

Laboratories rely on clean, legible request forms to process specimens within turnaround times. Incomplete or ambiguous forms delay results and frustrate both practices and patients. A standardized lab request form with digital intake forms integration keeps every order consistent across your practice team.

Required fields on a blood test lab request form

Regulatory frameworks – CLIA in the US, UKAS and CQC standards in the UK, and NPAAC in Australia – mandate specific data fields and handling, while data-protection rules like HIPAA (US) and GDPR (UK) govern how that information is stored and shared. Here is the full checklist every blood test requisition should cover:

Each field serves a specific regulatory or operational purpose. Omitting even one can cause delays or billing errors, so a good lab requisition form makes every mandatory field impossible to skip.

How to fill out a blood test lab request form

Completing a blood test lab request form accurately is a five-step process:

1. Enter patient demographics legibly. Print or type the patient’s full name, DOB, and MRN on every copy. Labs reject illegible entries, so double-check the patient’s ID against the form to prevent specimen mix-ups.
2. Select the test panel. Check off the specific tests you need (CBC, comprehensive metabolic panel, lipid panel, and so on). Do not write “routine labs” – be explicit. Different labs use different panel names, so verify against your lab’s form.
3. Document the clinical reason. Write the ICD-10 diagnosis code and a one-line clinical indication. Examples: “Z13.1 (screening for diabetes)” or “E11.9 (follow-up A1C for known diabetes)”. This shows the tests are medically necessary for insurance billing.
4. Specify specimen details. Indicate venous or capillary blood, the collection date and time, and any special handling instructions (fasting, specific tube type). An incorrect specimen type can invalidate results.
5. Add provider details and sign. Print your name, NPI (US), practice address, phone number, and signature (or electronic signature). Include your practice’s account number with the lab if you have one – it speeds processing.

Common mistakes to avoid: missing diagnosis codes (insurance will not pay), vague test descriptions (“tests ordered” instead of specific panel names), and illegible handwriting. Standardized healthcare forms and digital workflows remove these errors by enforcing required fields and auto-filling provider details, which is exactly what accurate clinical documentation depends on.

Free printable lab requisition form: formats and where to find one

The fastest way to get a free printable lab requisition form is to download the print-ready PDF at the top of this page, which you can fill in by hand or type into before printing. A few options exist depending on how you work:

• Our PDF template: a simple, generic lab order form you can print for any routine blood panel – useful as a lab slip for blood work when you need something today.
• Reference lab forms: Quest Diagnostics, LabCorp, and Mayo Clinic Laboratories publish their own requisition forms tied to their specific test menus and account numbers. Use theirs when you send specimens to that lab.
• A fully editable digital form: a static PDF or Word file still has to be filled in by hand each time. A digital lab request form inside your practice software is editable once and then auto-populated for every patient, so you stop re-typing the same demographics.

If you only need an occasional one-off order, a printable template is fine. If your practice orders blood work every day, the editable digital route below saves far more time than any downloadable file.

Blood test request form requirements by country

Field requirements and terminology vary significantly by country. This is the part most generic templates skip, so check your jurisdiction before you print:

If your practice operates in more than one country, use country-specific forms or make sure your template covers every required field for each jurisdiction.

Blood test request form templates by specialty

Different specialties often need slightly different forms tailored to their test panels and clinical workflows, especially metabolic health practices running frequent panels:

• Functional medicine and longevity practices: include advanced markers (micronutrient panels, functional medicine bloodwork, hormone panels). Order directly through reference labs like LabCorp or Quest Diagnostics.
• Hematology and oncology: emphasize specimen handling and priority turnaround. Include coagulation and cell count panels.
• Biochemistry and metabolic testing: focus on fasting requirements, specimen type (serum vs plasma), and specialty panels such as kidney and liver function, often ordered against diagnoses like K73.8.
• Microbiology: requires culture medium selection, transport conditions, and antibiotic sensitivity testing details.
• Pathology and tissue testing: includes biopsy specimen handling, fixative type, and tissue description fields.

Practices serving functional medicine practitioners often use custom forms that reflect their expanded test menus. Many reference labs (Mayo Clinic Laboratories, Quest, LabCorp) provide free downloadable forms specific to their test panels.

How Pabau automates lab request forms

Manual form completion is slow and error-prone, so practice management software like Pabau removes the friction by automating the whole lab requisition workflow. AI-powered clinical documentation and a connected patient record mean the form fills itself:

• Auto-population: patient demographics (name, DOB, MRN, insurance) fill automatically from the patient record, so your team stops re-typing details and making transcription errors.
• Provider details: ordering provider name, NPI, and practice address pre-fill from your practice profile – no hand-writing them onto every form.
• Digital ordering: send lab requests electronically to your reference lab, skipping paper forms and phone calls, with results returning digitally into the patient chart.
• Compliance enforcement: the system enforces required fields (diagnosis codes, specimen type) before submission, so incomplete orders never leave your practice.
• Integrated billing: HIPAA data handling is built in, with proper consent and audit trails for patient privacy.

With a practice management system that supports lab ordering, you can retire paper forms entirely and speed up test-to-result turnaround, so staff spend their time on patient care instead of paperwork.

See how Pabau simplifies lab ordering

Automate lab request forms, reduce errors, and speed up results delivery with digital ordering built into your practice software.

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Completing the form: best practices for accuracy

• Legibility and clarity: whether printing or typing, keep every field clear and unambiguous. Laboratories reject illegible forms and request resubmission, which delays results. If you are handwriting, use black or blue ink and print (do not use cursive).
• Check fasting requirements: some tests (lipid panel, glucose tolerance tests) require fasting. Note clearly whether the patient fasted, or whether the test can be run non-fasting. Labs may flag results differently based on fasting status.
• Specimen handling instructions: if special handling is needed (protect from light, keep on ice, room temperature), state it clearly. Different tests require different storage and transport.

One more check is just as important and belongs in its own callout, since it is the one most often overlooked:

Once results come back, log the next step with a patient follow-up form instead of relying on a phone call to track outcomes. Comprehensive patient management systems enforce these standards automatically, taking the burden off your staff and preventing costly errors.

The bottom line on lab request forms

A well-designed blood test lab request form is the foundation of accurate, timely laboratory testing. Whether you use a printable template or a digital system, the form has to capture patient identity, the tests ordered, the clinical reason, specimen details, and provider authorization.

Practice management software like Pabau removes manual form completion by auto-populating patient data, enforcing required fields, and enabling direct electronic submission to your reference lab. That cuts processing time, reduces transcription errors, and keeps billing compliant.

Ready to automate your lab workflows? Schedule a demo to see how digital lab ordering fits into your patient care.

Continue your research

Need a complete clinical documentation framework? The best EHR for private practice covers patient records, lab ordering, and clinical notes in one system.

Want to reduce patient no-shows and improve practice efficiency? How to improve patient no-show rate shows how workflow automation keeps patient data current and appointment adherence high.

Looking to strengthen your practice’s compliance posture? Patient scheduling software keeps every workflow, from intake to lab ordering, aligned to regulatory standards.

Frequently asked questions about blood test request forms