Laboratory Requisitions

On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The transition to ICD-10 is required for all organizations covered by the Health Insurance Portability Accountability Act (HIPAA).
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Order requisitions by contacting Client Services (contact info to the right). Requisitions may be customized.


Sample Requisitions

Look may differ in your area.

Clinical Standard Requisition with ABN

ABN (Standalone)

ABN (Spanish Standalone)

Cytology Requisition


Allergy Requisition – Oregon

Allergy Requisition – Vancouver

Allergy Requisition – NW Washington

Allergy Requisition – NW Washington IgG

Add-on Order/Fax Order/Standing Order

Obstetrics Requistion (pdf)

Used to submit add-on, fax or standing laboratory orders.​​​​​​​​​​​

PeaceHealth Laboratories