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General Requisition

Patient Information

Gender
Address
Address
City
State/Province
Zip/Postal

Billing / Insurance Information

Relationship

Diagnostic Profiles/Panels

Additional Tests/Profiles

Chemistry
Vitamin
Hematology
Microbiology
Tumor Markers
  • SST SPUN
  • USST UNSPUN
  • SER SERUM TRNSPT
  • FRZ FRS TRNS
  • R RED
  • LAV LAVENDER
  • SLD SLIDE
  • BLU BLUE
  • GRY GREY
  • GRN GREEN
  • RYB RYL BLUE
  • YEL ACD
  • PLS PLASMA
  • URN URINE
  • 24U 24 HR URINE
  • FL FLUID
  • SC STERILE CUP
  • BACT TRNSP
  • URN CUL TRNSP

Please be advised that medicare does not pay for screening profiles/panels. When ordering tests for medicare and medicaid patients, Please select only those tests that are medically necessary for the diagnosis or the treatment of the patient. For the composition make up of avantic medical lab panels, Please refer to the laboratory reference manual. Any profile component may be separately ordered as an individual test.

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