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STEPS TO STUDY ACTIVATION

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Complete IU Health Clinical Research Lab Request Form

This form is a guide for completing the IU Health Pathology Lab Requisition Form process for a new research study. If your study requires clinical labs to be processed at an IU Health facility, you can utilize this process to order and receive the clinical results. The process ensures proper pricing and CPT codes for labs, when building research study budgets. Sending the lab requisition form to labbilling@iuhealth.org ensures proper research billing and account setup for your study.

Resources

Completing the Requisition Form

  1. Start by clicking the link above and downloading the Clinical Research Lab Requisition Form. 
  2. Fill out all necessary information about the research study. 
      1. IU Health Research Teams will leave “Grant/Account” and “PO Number” boxes blank. Study teams should provide the email address where invoices can be sent in the “Special Instructions” box.
  3. Use the drop-down arrow next to “Test Name” to select all the appropriate lab tests you need the IUH Path Lab to complete as part of your study.
  4. If you will be requesting IU Health outpatient lab to draw the research labs when standard of care labs will not be drawn, select “Specimen Collection” as a test name.  This will allow the phlebotomy charge to be billed to study.
  5. The test menu provides lab test pricing and CPT codes for each lab test.
  6. Once all the tests are selected, save and send the from to labbilling@iuhealth.org.
  7. You will receive an email from Patti Jordan, stating that your lab requisition was received, and that your new account has been setup.

Using the Lab Requisition

  1. Once you receive the lab requisition workbook back from labbilling@iuhealth.org, the Req Tab will be populated. Print this tab out.
  2. Complete the Patient Information header.  All fields in the header MUST be completed in order for your labs to be processed. 
  3. Select the tests that will be drawn on that visit by checking the box to the left of the test name.
  4. If a member of the research team is drawing the labs, place a Cerner label on each tube and take/tube to an outpatient lab location with the lab requisition inside the bag. If a Cerner label is not available, a hand-written label can be used. Ensure that the patient’s name, MRN, DOB, date and time of collection are listed on the label. It may also be helpful to make a copy of the completed lab requisition for your records. 
  5. If labs will be drawn by IU Health phlebotomy team along with standard of care labs, take the requisition with you to the IU Health outpatient lab location and request the research labs also be drawn. Provide the requisition form to lab staff.
  6. If labs will be drawn by IU Health phlebotomy team and there are no other labs to be drawn, ensure the “Specimen Collection” box is also listed on the requisition and select it along with the labs to be drawn by checking the box to the left of “Specimen Collection” on the requisition.

If Applicable: IU Simon Comprehensive Cancer Center (IUSCCC) Additional Information

For studies using the Cancer Center’s Clinical Trial Office, please reach out to the finance team at cto-finance-l@list.iu.edu for assistance in lab requisition creation.

Contacts

labbilling@iuhealth.org 

Completing IU Health Clinical Research Lab Requisition Form is only one component of study activation. Additional requirements should be reviewed using the Clinical Research Roadmap.