Request a new Lab or Radiology Interface
Please submit this form once for each laboratory or radiology provider you wish to interface with.
Your E-mail (for important action items and status updates)
*
example@practice.com
If you'd like to include a colleague in status updates, include their email here
example@practice.com
Your Full Name
*
First Name
Last Name
Practice Name
*
Does your practice go by any alternate names? (optional)
Your Role
*
# of Physicians at your Practice (est.)
*
Which EHR do you use / will you be using?
*
Which Laboratory or Radiology Provider would you like to interface with? Please note that interfaces are not guaranteed and are subject to approval by labs/rads.
*
Quest Diagnostics
LabCorp
Other
If Other, please provide an email address for a laboratory sales representative or IT point of contact who can evaluate the cost of an interface. (strongly recommended)
example@lab.com
Do you want to receive results, or send orders as well?
I only want results in my EHR
I want to send orders from my EHR as well
How long have you been a customer of this laboratory or radiology provider?
*
0 months
1-3 months
3-12 months
12+ months
Recent estimated monthly ordering volume with this laboratory or radiology provider? (orders, not tests)
*
0-15 orders
15-30 orders
30-60 orders
60-90 orders
90+ orders
Do any of the following apply?
I'm switching to this lab or radiology provider from another one.
I'm switching EHRs (or recently switched)
I do not have a point of contact at this lab or radiology provider.
We are a newly founded practice / business.
Did you have an interface with your previous EHR?
yes
no
Which EHR are you leaving / who was your prior EHR vendor?
If you are not using your new EHR yet, do you have a planned start date with your new EHR?
-
Month
-
Day
Year
Date
Please note that as a next step, you will need to initiate contact with your laboratory or radiology provider. We will provide instructions to let you know how to do this, and how to notify us when complete.
*
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Please verify that you are human
*
Submit
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