Out Patient Lab Orders
[Pages:1]Out Patient Lab Orders
Fax or have the patient bring the orders to the lab draw station
Patient name: _____________________________ Patient DOB: _____________________________ Test date: __________________
Test:_________________________ ICD-9____________________
Test:_________________________ ICD-9____________________
Test:_________________________ ICD-9____________________
Test:_________________________ ICD-9____________________
Test:_________________________ ICD-9____________________
Test:_________________________ ICD-9____________________
For test directory : ? services-laboratory
Priority: Please circle below
Routine
Stat
Notification: Call_________________________ Fax:__________________________
Ordering Provider Signature:___________________________Date:_________
Testing Location
Adventist Medical Center - Main Lab
Gresham Station
10123 SE Market St, Portland, OR 97216
831 NW Council Drive, Suite 120
(located on 1st floor)
Gresham, OR 97030
Phone: 503-251-6126 Fax: 503-251-6378
Phone: 503-489-2678
Hours: 24/7 service
Fax: 489-2679
Hours: Monday-Friday 7:00 am- 5:00pm
Pavilion Lab ? lab draw station 10000 SE Main St, Suite 114, Portland, OR 97216
Fishers Landing 417 Se 164th Ave, Suite 300
(on medical center campus)
Vancouver,WA 98684
Phone: 503-251-6110 Fax: 503-261-6629
Phone: 360-896-6944
Hours: Monday ? Friday, 7:30 a.m. ? 4:00 p.m.
Fax: 360-254-2894
Hours: Monday- Friday 8:00 am ? 1145 am
Professional Office Building 3, Suite 24 ? lab draw station
10201 SE Main St, Suite 24, Portland, OR 97216
(on medical center campus)
Phone: 503-251-3867 Fax: 503-251-6378
Hours: Monday ? Thursday 8:00 a.m.? 4:00 p.m, Friday 8:00-1300
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