Pick Up Request Form

Columbus area Courier 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 recieved BEFORE 4 pm will be picked up the same day/evening.

All requests received 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
Phone Number*
Please enter a valid phone number.
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.cbus@ildp.com
All requests recieved BEFORE 4 pm will be picked up the same day/evening.

All requests received AFTER 4 pm will be picked up the following day.
Should be Empty:

Columbus area Courier Pick Up Request Form

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