Requisitions

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2515 Bernadette Drive Columbia MO 65203
573-777-8600 | CLIA # 26D2168886

Please circle the name of the current provider.

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Sex

Each test must have an ICD 10 code to indicate medical necessity. When ordering tests for which Medicare or Medicaid reimbursement will be sought, only tests that are medically necessary for diagnosis or treatment should be ordered. All tests and supporting rational must be documented in the patient medical record.

Insurance Info: Attach copy of front & Back of Insurance card or face sheet

Insurance Type
Test Name

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Ship To
Helix Specialty Diagnostics
2515 Bernadette Drive Columbia MO 65203
Notify UPS of specimen pickup – 800-742-5877

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The shipper is required to comply with the rules and guidelines for transport of medical specimens set forth by DOT and FAA. Failure to follow instructions for packaging and shipping can result in delay, or loss of your specimens.