Urine Toxicology Requisition Guide

1. Urine Toxicology Requisition Guide We stand by our results because we know you depend on them. Click Enter or Arrow to advance to next slide

2. Section A: Clinic Information • Options • Enter Clinic Name & Address • OR • Enter Clinic Account Number (provided in Enrollment Confirmation Letter) • OR • Affix custom Clinic Requisition Label (request via website at • www.crestarlabs.com/order-supplies • Specimens cannot be processed without Clinic Information Click Enter or Arrow to advance to next slide

3. Section B: Sample Information • Print Provider Name • Date specimen collected • Collector Initials • Indicate Specimen Type as Urine • Specimens cannot be processed without Requesting Provider Click Enter or Arrow to advance to next slide

4. Section C: Patient Information • Patient First & Last Name • Patient DOB • Patient Address (may provide from EMR printout) • Current Medications (may provide from EMR printout) • ICD-10 Codes (must reflect Medical Necessity) • Insurance Information • Req captures Primary • May provide from EMR printout • Send copy of allpayor cards • Send copy of DL • Must indicate Primary/Secondary Status • Missing Information will result in reporting and billing delays Click Enter or Arrow to advance to next slide

5. Section D: Presumptive Testing • Options • None – no Qualitative testing desired • POCT – Point of Care Testing performed at clinic. May report positive results to prompt Confirmation Testing • Specimen Validity – pH, Creatinine, & Specific Gravity only • Full Screen – Includes Specimen Validity + Screening of 12Drug Classes. Positive results will undergo Confirmation/Qualitative Testing • Do not request Full Screen if clinic performs & bills for POCT testing or a High Complexity Analyzer test. If ignored, duplicate billing will occur and clinic claim will be denied. Click Enter or Arrow to advance to next slide

6. Section E: Confirmation Testing • Confirm Medications – must provide current medications • Individual Class or Analyte Orders • Checkbox beside Class heading – orders all analytes within the class • Checkbox beside Medication – orders only the analyte and relevant metabolites • Panels Orders • Enter TOXL, TOXM, or TOXH Patient Risk Panel under Provider-Defined Panel Urine Panel Code • May order additional classes or analytes by marking desired test • Rules for Medical Necessity must be followed when ordering class(es), analyte(s), or Risk Panel(s) Click Enter or Arrow to advance to next slide

7. Section F: Authorization Patient Signature – Required for billing purposes Provider Signature – Required for billing purpose Specimens will not be processed without a Provider Signature Requisitions missing signatures will be faxed to the clinic to request a signature. Specimens will be processed once the requisition is faxed back with a valid signature. Click Enter or Arrow to advance to next slide

8. Lastly: Requisition Labels • Used to connect specimen to paperwork for integrity purposes • Affix label from requisition to collection device • Label device with at least 1 additional unique identifier • Do not label device lids • Acceptable Unique Identifiers • Patient Full First & Last Name • Patient DOB • Requisition label • Specimens lacking 2 unique identifiers will be marked as such. Integrity of the specimen source cannot be confirmed. Click Enter or Arrow to advance to next slide