Lab Forms & Test

Ordering Physician: Gentox Clinical Solutions Inc. provides preprinted order forms containing the account's address and providers' names. Please check the name of the provider ordering the test, or write the provider's name if it's not listed.

Patient Information: Record the patient's information, including their name, address, sex, phone number, date of birth, social security number, and email address, where available. Also, mark the patient's insurance type. Fill out the applicable fields on the security label as well.

Diagnosis Codes: Record the appropriate diagnosis codes for the patient's condition.

Test(s) Requested: Please record the test(s) ordered for each patient. Either check the appropriate test box or write in the desired test(s).

Collection Information: Mark the sample type (urine or oral fluid), time and date collected, and collector's name. Also, if a point-of-care drug testing device or analyzer is used, please mark the results of these tests as either positive or negative. Aeon will provide the results of these tests in the final report.

Current Prescribed and OTC Medications: Please mark the patient's current prescribed and over-the-counter (OTC) medications, or write them in the blank spaces. If the patient has not been prescribed any drugs, please check "No Drugs Prescribed."

Physician Signature: Please have the ordering physician sign the bottom of the form. No signature is necessary if it is on file with Aeon.