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Specimen Labeling/Request Form Completion

Collection Procedure:

LTD Specimen Labeling/Request Form Completion   Version 6

Specimen Labeling and Request Form Completion


The purpose of this policy is to describe the process of labeling laboratory

specimens and proper completion of laboratory requisition/script.


At Collection:

- It is the responsibility of the collector to ensure all specimens are labeled

correctly in the presence of the patient or appropriate adult.

- Specimens must be submitted to the laboratory with proper requisitions or


Upon Receipt in Laboratory:

- The laboratory is responsible for ensuring that information obtained from

the specimen and requisition match.

- Any discrepancies found between specimens and associated

requisitions MUST be questioned with collectors

- Incorrectly identified specimens or specimens without necessary Blood

Bank documentation MUST be recollected.

Applies to: All specimens received in an Akron Children’s Laboratory


All specimens must be labeled at the side of the patient prior to leaving the

room. All specimens coming into the laboratory are required to be labeled as

stated in the guidelines.

All specimens sent to the laboratory must be accompanied by a requisition/audit

slip which contains the same two patient identifiers used to identify the patient

and the information as detailed in the section of the request form. (Labels from

the lab system may substitute for a requisition as they contain all pertinent


Blood Bank Specific Information:

Ordering through EPIC- the required patient and transfusion history must be

completed by the APP.

Ordering outside of EPIC- a manual Blood Bank Requisition must be

completed which includes the history sections mentioned above.

In either case a completed Blood Bank requisition is required to include the

signature of the APP ordering the test.

Specimen Labeling/Request Form Completion; Version:6 Page 2 of 4

In addition at the time of specimen collection the two signatures (collector and

witness) verifying the identification of the patient should be placed on the

Blood Bank requisition.


1. Two patient identifiers from the identification band or provided verbally if no

band is present and from the order (script, request form, audit, order labels)

must be compared at the time of collection.

2. After collecting the specimen and before leaving the patient room/bedside,

label each collection tube/container, using a patient label generated by the

hospital or laboratory system or handwritten.

The label MUST contain:

Two patient identifiers (patient’s full name and medical record number

and/or date of birth)

Date of collection

Collectors employee number - The phlebotomist is identified by placing

the employee number on the specimen container. This will then be

entered into the LIS at accessioning to become part of the permanent


In case of unidentified patients, label should contain assigned patient

name at time of collection and both the medical record and account


Room number and bed are not acceptable identifiers!

3. Special circumstances require the following additional information on the


Specimens sent with an audit slip or laboratory requisition.

Time of collection when specimen is for Blood Bank or one drawn in a

series; e.g. Glucose Tolerance or Stimulation Tests.

The employee number of the individual collecting the specimen must be

on all Blood Bank specimens.

Specimens sent with no paperwork (Not applicable to Blood Bank); e.g. script

or lab labels only

Specimen Collector ID hospital employee number (initials if not an

employee). (In a trauma situation an alternate staff member who has

verified the two patient identifiers may write the employee number of the

individual who drew the blood and add their own initials.)

Time of collection


- Blood capillary or venous

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- Urine cath, clean catch, etc.

- Swab throat, NPH (nasopharyngeal), wound (MUST add location, ex.

Right (R) Leg)

Transport of a newborn (the referring hospital is sending mother’s blood)

The mother’s blood must be labeled with her full name, date of birth, the

date of the draw, and the initials or signature of the person drawing the


A completed Transport Form to Accompany Mother’s Blood’ must be

sent to the lab with the specimen.

Request Form:

1. All requests for Blood Bank Testing must be submitted on a double

signed Blood Bank requisition (Epic or manual).

The requisition must be completed and signed by the ordering APP.

The patient history and transfusion history sections are critical to patient


Any departments ‘live’ on Epic must place Blood Bank orders in Epic.

The manual requisition is a requirement for all non-Epic sites collecting

Blood Bank samples to be sent to Akron Children’s Hospital Blood Bank.

2. For Inpatient areas using audit trails, complete the blanks requesting

collection time, employee ID, and source capillary, venous, arterial.

3. For Inpatient/Outpatient areas sending a request form which accompanies an

already drawn specimen, the following information should be on the request


Patient Information

- Two patient identifiers which were used to identify the patient

- Sex male or female

- Clinical information when appropriate e.g. Patient History for Genetic

testing, Time of dose of medication for drug level (peak or trough), etc.

Specimen Information

- Collection date and time

- Source - e.g. urine, wound, NPH

- Descriptive information, e.g. left or right, clean catch or catheter, peak

or trough, capillary, venous, or arterial, pertinent to the report.

- Tests requested

Physician Information

- Full name and for outpatients the National Provider Identification

number (NPI)

Report Routing Information

- Inpatients Patient location where report should be sent.

- Outpatients – Physician’s address/location

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4. Transportation of a newborn (delivering mother’s blood to ACH lab) the form

titled ‘Transport Form to Accompany Mother’s Blood’ must accompany the

mother’s blood to the lab. In addition the baby’s label will be placed on the

mother’s blood in such a manner that both may be read

5. For outpatient physicians sending a script requesting laboratory testing,

the following information must be provided.

Patient Information

- Name and date of birth

- Clinical information when appropriate e.g. Patient History for genetic

testing, time of dose of medication, etc.

- ICD-10 code and/or diagnosis.

Specimen Information

- Order date and time

- Tests requested

- Specific information, i.e. clean catch or catheter for a urine culture.

Physician Information

- Full name and for outpatients the National Provider identification

number (NPI) for non-Akron Children’s physicians.

Routing Information

- Inpatients Patient Unit

- Outpatients – Physician’s address/location

Blood Bank Disclaimer:

Mislabeled Blood Bank specimens will not be processed, regardless of the

situation. This includes any mismatched or missing information involving

the specimen and/or the Blood Bank requisition. All mislabeled Blood

Bank specimens will be redrawn.


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