With Aculabs opening up its services to physician offices in the coming months, we are making a concentrated effort to streamline the onboarding process. We have set up the following introductory web form for doctor’s offices to fill out to assist in this startup and onboarding process.

  • Physician
  • Office
  • EMR
  • Results
  • Specimen
  • Compliance

FORM CONTACT INFORMATION

PHYSICIAN CONTACT INFORMATION

OFFICE CONTACT INFORMATION

Please select your days of operation: (required) SunMonTuesWedThursFriSat


Select all applicable staff: (required) Office ManagerIT CoordinatorBilling Coordinator



EMR / PRACTICE MANAGEMENT SYSTEM INFORMATION


Use for result delivery: (required) YesNo

Use for Order Entry: (required) YesNo

Uni or Bi-Directional: (required) Uni-DirectionalBi-Directional

RESULT DELIVERY INFORMATION

Preliminary or Final Results: (required) PreliminaryFinal OnlyBoth

EMR: (required) YesNo

AutoFax: (required) YesNo

Fax Machine Needed (required)
Select any additional delivery methods: (required)
In-House Print/Courier Hand DeliveryMobile DeviceOnline/Office Self-RetrievalNone

SPECIMEN COLLECTION INFORMATION

In-Office Phlebotomy will be performed via: (required) Practice StaffAculabs PhlebotomistN/A

Will refer patients to Aculabs PSC: (required) YesNo

Specimen pickup required by courier: (required) YesNo
Aculabs Specimen Box Location: (required)
Special Pick-Up Instructions:
If specimen box is located inside, does building ever lock?: (required) YesNo

Specimen collection supplies and/or office supplies needed: (required) YesNo
If yes, please download our supply order form, fill it out, and submit it.

Manual requisitions needed: (required) YesNo

In-office phlebotomy workstation supplies needed: (required) YesNo
In-office phlebotomy workstation supplies required: (required)

AUTHORIZATION & COMPLIANCE INFORMATION

Did you request an in-office phlebotomist?: (required) YesNo
Click here to download a blank NJ Collection Station License application
Please attach a completed NJ State Collection Station application: (required)
Click here to download a blank Physician IOP Compliance Acknowledgment Form
Please attach a completed and signed Physician IOP Compliance Acknowledgement Form: (required)

Insurance & Billing special requests/comments:

General Practice special requests/comments: