Notice: Please ensure that we have all updated facesheets. Facesheets can be emailed to This information will be required to make Online Order Entry as quick and efficient for your nursing staff as possible. It may be easier to allow us access to your EMR. 

Please ensure that all files are properly compressed and appropriately encrypted before sending. 

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      Facility Info

    • 2

      Staff Info

    • 3

      Nursing Staff

    • 4

      Unit Info

    • 5

      Billing Info

    • 6



    Facility Info

    Facility Contact Information


    Administrator Information

    Director of Nursing Information

    Business Office Information

    IT Department Information


    Assistant Director of Nursing Information

    Staff Educator Information

    Infection Control Contact's Information


    Facility Unit Information

    Specimen Fridge Information


    Face Sheet Information

    Invoice Information

    Accounts Payable Information

    EMR System Information

    Can we have access to your EMR system? (required)

    Your EMR System (required)

    If "other", please specify what EMR system you use (required)

    Payor Type Information

    Do you have Part A Days? (required)
    Do you HMO Days? (required)

    Daily Census Information

    Monthly Census Information

    Bed Type Information

    Do you have AL and/or IL beds? (required)

    Do you have an ABN on File for Medicare Part B patients? (required)
    (If not, click here to download our blank ABN form)


    Placing Standing Orders

    If your facility currently utilize standing orders (aka reoccurring orders), will you be able to provide a trash-run of your current reoccurring orders?

    Notice: It is vitally important that the standing orders indicate the months the orders are to be drawn. If the list of standing orders does not include dates, it will be necessary to ascertain the dates or make a decision on what dates you wish us to input all of your reoccurring orders. It will be important to make sure the laboratory orders we receive coincide with your physician’s orders.

    Submitting Physician Information

    Please ensure your file is in .pdf, .doc, or .docx format and under 5MBs in size.

    To help assist us as much as possible, please be aware that you'll need to assemble a listing of information you have on relevant physicians. This listing should include physicians' names, addresses, phone numbers, fax numbers, and NPI numbers. You may submit it as an attached document for convenience.