Sample Test Requisitions

To order the Litholink 24-hour urine tests, you must be a registered labcorp client with an account number. You can order electronically through an EMR, labcorp Link, or manually with this Test Request Form. (Please print and complete this Test Request Form off if you wish to use manually.)

Test Requisition Instructions

Complete all required fields on test requisitions. Ensure that all required fields are filled out and the information submitted is accurate.

Provider: Ordering physician name, address, phone #, physician/authorized signature, NPI #, Labcorp account #
Patient: Name, gender, DOB, Shipping address for faxed orders
Clinical: ICD-10-CM
Tests/Panel: Select tests to be performed

Test Request Form (SAMPLE)

Samples of Test Request Forms (PDFs) may be viewed and downloaded here. If necessary, download Adobe Acrobat Reader.