Pick Up Request Form

HOLIDAY SCHEDULE

Thanksgiving Day, November 23, 2023 - Facility Closed

November 24, 2023 - Short Day * Pick Request must be received by: 2pm

December 1, 2023 - Half Day * Pick Request must be received by: 12pm

Christmas Day, December 25, 2023 - Facility Closed

December 26, 2023 - Short Day * Pick Request must be received by: 2pm

New Years Day, January 1, 2023 - Facility Closed
Pick Up Request Form

Please complete the form below to submit a specimen pick up request.
* Please wait until the patient's specimen has been collected before requesting a pick up.
All requests sent BEFORE 4 pm will be picked up the same day/evening.

All requests sent AFTER 4 pm will be picked up the following day.
Facility Name*
Number of specimens ready for pick up*
Type of Specimen*
Urine, COVID, Respiratory, etc.
Patient Initials*
If you have more than one specimen, separate patient initials by a comma (,). If you have more than five, you may enter "MULTIPLE".
Where to collect specimen*
Lockbox, fridge, nurses station, etc.
Your Name*

First NameLast Name
Your Email
*For optional confirmation message
Facility Address*

Street Address

Unit (i.e; Memory Care, TAL, Health & Rehab, etc.)

CityState / Province

Postal / Zip Code
GENERAL INFORMATION

- Patients NAME and DATE OF BIRTH needs to be clearly written on the specimen.

- Input all information on the requisition form in LIMS, including any updated personal information and corresponding ICD codes.

- Patient insurance information needs to be completed on every requisition form.

- Print patient requisition form and place inside of the biohazard bag pocket with the patients specimen.
IF YOU NEED TO SPEAK WITH THE COURIER SUPERVISOR DIRECTLY

Tina Karson

513.866.7922

pickup@ildp.com
Should be Empty:

HOLIDAY SCHEDULE

Pick Up Request Form

* Please wait until the patient's specimen has been collected before requesting a pick up.