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Header Information
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Ordering Provider:
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Patient Information:
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Dx Code:
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DI: Major Depressive Disorder
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DI: Other Disorders
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DI- Substance Use Disorders:
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DI- ADHD
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DI: Bipolar
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DI: Eating Disorders
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DI: Cognition
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DI: (If not listed as favorite above)
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Controlled Substance Prescription Lab Order: CBC, CMP, TSH, Vitamin D
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Urine Drug Screen
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ECG/EKG
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Geriatric/ Cognitive Medication Lab Orders: CBC, CMP, TSH, Vitamin D, RPR
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Urine Analysis
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ECG/EKG
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General Medication Lab Orders: CBC, CMP, TSH, Vitamin D, Lipid Panel (Fasting)
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Urine Analysis
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ECG/EKG
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Lithium Level Lab Orders
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Valproic Acid Level Lab Orders
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Carbamazine Lab Orders
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Additional Laboratory Requests
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FAX BACK INFO
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