To order lab supplies, please choose one of the following:
To add a test
An Advance Beneficiary Notice form is submitted if patient is of Medicare age, does not have an approved diagnosis, and therefore must pay the test's cost out-of-pocket. The physician's office completes this form and the patient must sign it prior to the test.
Below is a partial list of approved Alegent Health Reference Laboratory Requisitions and instructions for completing them. When these requisitions are presented to the patient service centers (PSC) and the Diagnostic Centers (DC) the patient will receive reference laboratory pricing.
- NextGen EMR Requisition (LOS)
- NextGen EPM Requistion
- Physician Office EHR Requisitions
- Web Connect Requistion
Alegent Creighton Health manual lab requisition examples and instructions for completing them.
- Anatomical Pathology (APR) Requisition
- General Lab Requisition - (Green)
- Instructions for completing Anatomical Requisition
- Instructions for completing General Lab Requisition
Lead, Urine, Alpha Fetoprotein, Quad Screen forms
If you have any questions about forms please call (402) 717-5227.