Specimen Collection Locations and Requisitions
Monday - Friday, 7 a.m. - 5 p.m.
Saturday, 7:30 a.m. - 2 p.m.
Specimen collection is also available outside of the above hours;
however, significant waiting time may be necessary.
West Dodge Medical Plaza
515 N. 162nd Ave
Omaha, Nebraska 68118
|Monday – Friday, 7:30 a.m. – 4 p.m.|
Methodist Women's Hospital
First Floor, Radiology
Monday - Friday, 7:30 a.m. - 4 p.m.
Laboratory Test Order Forms
- Laboratory Test Order Form
- Clinical Pathology Requisition
- Anatomic Pathology Requisition
- Outreach Pathology Referral Requisition
- Outreach Pathology Referral Fax Cover Sheet With Instructions
- NCL FISH Referral Request Form
- ARUP Maternal Quad Screen / AFP History Form
- ARUP Pain Management Panel Medication List Form
Laboratory Specimen Add On Form - Please Complete and Fax to 402-354-8806
Please ask patients to have current insurance information available and ICD 10 code.
Medicare NCD Guidelines ICD 10 2016
Related Link: Local Medical Review Policies