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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