Supply Order Form -- order supplies electronically or, by fax or courier

Informed Consent Certification
Specimen Labeling, Acceptance/Rejection Policy
Medicare Notice for Ordering Physicians
Panels and Profiles
Pickup
Reference Values
Reporting
Supply Order Form
Blood Bank Specimens
Call-Back Toxic Concentration Levels
Critical Values

Informed Consent Certification
Submission of an order for any catalog tests constitutes certification to Mayo Medical Laboratories by the ordering physician that the ordering physician has obtained:

• "Informed Consent" of the patient as required by applicable state or federal laws with respect to each test ordered
• Patient authorization permitting Mayo Medical Laboratories to report results of each test ordered directly to the ordering physician

Medicare Notice for Ordering Physicians
Advanced Beneficiary Notice
Medicare will only pay for items and services it determines to be "reasonable and necessary" under section 1862(a)(1) of the Medicare law. If Medicare determines that a particular item or service -- although it otherwise would be covered -- is "not reasonable and necessary" under program standards, Medicare will deny payment for that item or service. Medicare does not pay for laboratory tests that "screen for abnormalities" or for "routine" laboratory tests. If you think Medicare may deny the tests you are ordering, the patient must be informed and an advanced beneficiary notice (ABN) must be signed.

Medical Necessity
Please provide ICD-9 codes for the tests ordered on the requisition to document the medical necessity for these tests. Be careful when ordering panels or profiles to ensure the medical necessity of all tests contained within the panel or profile. The Balanced Budget Act of 1997 requires physicians to provide diagnostic information when ordering tests for which reimbursement from the Medicare program will be required if that information is necessary for payment.

Panels and Profiles
The Network Reference Laboratory uses Mayo Medical Laboratories reference testing services. Many of the laboratory tests, panels and profiles that Mayo edical Laboratories perform for Network Reference Lab are identified and listed in the directory of services. The tests, panels and profiles have been established in accordance with Mayo Medical Laboratories policies and procedures. Any listed profile that contains multiple CPT codes should be treated as a profile for purposes of Medicare. The ordering physician should requisition the profile only if its components are medically necessary for the patient. If the test components are not medically necessary, the physician should order only those that are.

Pickup -- 314.653.4455 or toll-free 800.533.7720
Regularly scheduled courier pickups:

• 8 a.m.-7 p.m. Monday-Friday
• 8 a.m.-4 p.m. Saturday

Call to schedule off-hours pickups.

Reference Values
All reference values listed are for adult normals at Network Reference Lab unless otherwise indicated.

Reporting
You can receive test results by:

• Courier
• Online -- with a printer terminal
• Telephone
• Fax

Most frequently requested tests are completed and reported within 24 hours following receipt of specimen.