Please use this form to upload a paper lab order from a provider outside of Jefferson Healthcare who cannot send orders electronically or by fax. Submitting your order in advance allows our lab team to review it before your arrival and may reduce wait times.
Please enter your name and phone number and upload a clear photo of each page of your order. Make sure all information is easy to read before submitting.
To be processed, the order must include:
- Patient full name
- Patient date of birth
- Diagnosis code(s) or reason for testing
- Test(s) requested (name and/or procedure code)
- Signature from the ordering provider (MD, DO, Nurse Practitioner, or Physician Assistant)
- The signature must be handwritten or say “electronically signed by”
- If signed by a Registered Nurse (RN), the order must also include a provider’s signature
- Date and time the order was written
Orders that are missing required information or are not legible may require follow-up before services can be scheduled.