Medical
Requisition Form for Phlebotomy
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Requisition Form for Phlebotomy

1
Patient Identification
2
Explanation of procedure to patient
3
Obtain consent from patient
4
Prepare the requisition form
5
Complete patient details on the form
6
Indicate type of test(s) to be performed
7
Prepare the patient for venipuncture
8
Perform the venipuncture
9
Label the collected samples
10
Record date and time of collection on the form
11
Inclusion of any special instructions
12
Seal sample in a biohazard bag
13
Handover of the filled form and sample to the courier
14
Ensure receiver's signature on form
15
Approval: Signature Verification from Phlebotomist
16
Scan the completed form
17
Upload the scanned form in the system
18
Disposal of used phlebotomy materials
19
Sanitize the workstation
20
Update patient's record with collection information