Develop a Request Form for Laboratory Testing


It is crucial that a Request Form is made that automatically persuades clinicians to provide all information that could be relevant for correct laboratory testing.


Develop a Request Form that at least includes room for at least the following information:

  • Patient details (name, address, telephone number, birth date, gender, etc.)
  • Requester details
  • Type of primary sample
  • Examination(s) requested
  • Clinical information relevant to the laboratory
  • Date, time and place of sample collection
  • Date and time of receipt of the sample at the laboratory
  • Any other relevant information


In the right-hand column a template of a request form is provided. Adapt this form to the situation applicable to your laboratory (e.g. replace the examinations indicated on the template for the examination provided by your laboratory). Include clear guidance on how to fill-in the Request Form (this is not provided in the template form). E.g.: print clear instructions on the backside of the request form on how to fill out each section of the form and what information should be included in each section.


For Tuberculosis laboratories specifically the WHO has developed TB Reporting and Reporting Forms that contains a template of a TB laboratory testing request form. [TB] WHO has also developed the “Definitions and Reporting Framework for tuberculosis”. This manual contains templates of various forms needed by TB laboratories. Find these templates in section B3.1 of this manual and on the right column of this page.

How & who

Quality Focal Point (together with a staff member who can provide useful input on developing the Request Form):

  1. Develop the Request Form including the required elements summed-up above (see ISO 15189:2007 article 5.4.1 and ISO 15189:2012 article 5.4.3).
  2. Present the Request Form in a weekly staff meeting and ask for suggestions for improvement. Some staff members may have valuable suggestions which you may not have thought of when making the form.
  3. Present the Request Form to several clinicians and also ask them for suggestions for improvement. Clinicians have a different perspective that could lead to some valuable suggestions for improvement.
  4. Optimize the Request Form based on the suggestions for improvement received from both the laboratory staff and the clinicians.
  5. Print the Request Form: make as much copies as needed to provide all the clinicians that regularly request laboratory testing with enough forms. Notify the clinicians that they have to contact the laboratory if they need more Request Forms. Explain the clinicians that they have to start using the new Request Forms as from now and throw away all the old Request Forms.
Back to Roadmap Activity Overview
This activity is part of the QSE Process Management
ISO15189:2007: 5.4.1
ISO15189:2012: 5.4.3