Forms and Requisitions

Test request forms:

Ordering: 

• For requisitions please contact client services or fill out a supply form (see “Supplies”).
• Additional forms for ordering:
• Additional / Add-On Test Request
• Blood Bank Specimen Form
• Cancel Testing Form
• ABN (Advanced Beneficiary Notice)
• Phone/Verbal Orders from Provider
• Electronic Ordering – EpicCare Link

Results:

• Corrected Report – Gen Lab
• Corrected Report – Pathology
• Medical Records
• MyChart

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Supplies

• WEST MICHIGAN

(ATL, Big Rapids, Blodgett, Butterworth, Gerber, Grand Rapids, Greenville, HDVCH, Ludington, Reed City, Pennock, Zeeland)

• • Independent Outreach Client Supply Order Form
  • CH/CHMG West Supply Order (X24639) 
    • Workday Crosswalk
  • Office Moving or Discontinuing Services Update 
• SOUTHWEST MICHIGAN

(Niles, St. Joseph, Watervliet)

• • Inventory Stocked by CS
  • Internal Supply Order Form
  • Outpatient Draw Sites Supply Order Form
  • Outpatient Supply Order Form

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Billing

• ABN (Advanced Beneficiary Notice)
• Adjustment or Credit for Patient Billing
• Coding Quality Information
• Update Diagnosis Code Instructions 

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Other

• Corewell Health West NEW Lab Client Request 
• Office Moving or Discontinuing Services Update 
• Provider Updates
• Laboratory Locations (CHS/CHW) flier (X18870)

 

 

Updated: 1/8/2025