Ordering Tests

How to Order Testing

UCSF physicians should place all clinical laboratory test orders via APeX. Non-UCSF physicians are encouraged to sign up for MD Link access which will allow them to place orders and receive results electronically.  In the event that computer physician order entry systems are unavailable, the UCSF Clinical Laboratories will accept paper orders, provided they contain all necessary information, including adequate patient identification information, patient sex, date of birth, name and address of authorizing physician, and ICD-10 codes.  To ensure all these elements are present, we strongly encourage providers to utilize the downtime requisition available through this website.

If you are an outside institution interested in using the UCSF Clinical Laboratories Outreach Services, please click here to learn more.

Please note, some specialty send out tests (particular genetic testing) may require vendor specific paperwork.  Please check with the performing laboratory and ensure that all necessary paperwork is complete and that the patient presents these forms to phlebotomy at the time of specimen collection. Also, per the Chief Genomics Officer, genetic testing on inpatients requires a Genetics consultation prior to ordering the test.

Who May Order Laboratory Tests?

Under California Business and Professions Code section 1288: 

"Any person conducting or operating a clinical laboratory may accept assignments for tests only from and make reports only to persons licensed under the provisions of law relating to the healing arts or their representatives…" 

In order to be "licensed under the provisions of law relating to the healing arts", the healthcare practitioner must be licensed in the state of California as a physician and surgeon, or licensed as a healthcare provider with a scope of practice that authorizes ordering clinical laboratory tests. If the test results can be lawfully used by the healthcare provider to diagnose, manage or treat the patient, then it would likely be appropriate for that healthcare provider to order the test.

Although in 2002 California state law (SB1131) made it allowable for patients to self-order laboratory tests that are normally available as over-the-counter tests from pharmacies. Due to payment and reporting constraints, the UCSF Clinical Laboratories do not accept patient self-orders for laboratory tests. If patients wish to self-order tests they should be referred to a commercial laboratory that accepts such requests.

Furthermore, for reimbursement purposes, requests for outpatient testing must carry the name of an identifiable individual who is recognized as authorized to order tests in California. Unless charged to a budget/research account, outpatient orders cannot be submitted in the name of a medical student, nurse practitioner, registered nurse, licensed vocational nurse, or anonymously as "Fellow" or "Resident", etc.; in each case, the laboratory order must include the name of an individual licensed provider who is taking responsibility for the orders.

Non-routinely Orderable Tests

It is not always practical or feasible to validate laboratory tests on all specimen types (e.g. body fluids and stool). However, when necessary for clinical management such non-routinely orderable tests may be performed at the provider's request and clinical laboratories' discretion. In submitting such an order, the provider should understand that tests on these specimen types are not FDA approved or validated by the UCSF Clinical Laboratories and that the results should be interpreted with caution and should not be used without other supporting data for medical decision making. Further, reference ranges that may be showing with the test result are not applicable to these sample types. With respect to body fluid testing, comparison of test results to a concurrent serum sample may be beneficial.

Test cancellation

The UCSF Clinical Laboratory will try to honor requests from the ordering physician to cancel a test(s) up to the point that testing has begun. After that point, a test cannot be cancelled or the result removed from the patient record.

If a test is cancelled the patient will not be charged for the cost of the test, although there may be a specimen collection and processing charge for the sample. If the test was referred to an outside laboratory and cancelled before a result was generated, any charges incurred by UCSF for shipping the sample or charged by the outside laboratory will be passed on to the patient.

Charging Tests to Another Patient's Account

Under exceptional circumstances, we will perform a test on a secondary individual, for example a relative, and charge the patient. These situations will be evaluated on a case-by-case basis, but can occur:

  1. when HLA Typing a related prospective renal or marrow transplant donor. 
  2. when the sample is from an unborn fetus. 
  3. when the patient's diagnosis can be made only by testing someone else, and is likely to alter management. A patient with partially-treated bacterial diarrhea, from whom a pathogen is not isolated, could have an untreated, mildly symptomatic relative who still may have a positive culture, permitting better management of the culture-negative case.
  4. when the results from one or both parents are needed in order to interpret the results of test on their child for inherited genetic disorders.

Tests will NOT be charged to another patient's account when it will not be reimbursed by insurance carriers or other third parties. A specimen should NEVER be intentionally labeled with the wrong name, even when it is proper to charge another patient's account.

Donor samples:

Tests will be ordered on the recipient’s medical record number/account and will appear in APeX under that number. The result field for donor samples will contain "PERFORMED ON DONOR SAMPLE, SEE COMMENT" with the actual results listed in a comment following the result line. This clearly identifies the results as belonging to a donor and not the recipient.

Fetal samples:

Tests will be ordered on the mother's medical record number /account and will appear in APeX under the mother's medical record number. The result field for fetal samples will contain "PERFORMED ON FETAL SAMPLE, SEE COMMENT" with the actual results listed in a comment following the result line. This clearly identifies the results as belonging to a fetus and not the mother.

Samples from Another Individual:

When a diagnosis requires testing another person: The individual on whom the test is to be performed must be registered and given a distinct unit number separate from that of the patient, or given a temporary unit number. This prevents the result of the test from being posted to the patient's record and accidentally mistaken for their result. The test will be billed to the patient's account.

Add-On Requests

Tests may be added on to existing samples provided that an appropriate sample type is available and the stability period for the test(s) being requested has not been exceeded.

Add-on orders should be placed in APeX. If sufficient sample is available, testing will be performed and resulted. If there is insufficient sample volume to perform the requested testing, the add-on will be resulted as “quantity not sufficient”. If the testing is still desired, then an order for a new sample collection will need to be placed.

 For orders that are not placed in APeX (e.g. non-UCSF providers) we do accept telephone add-ons by calling the laboratory at 415-353-1667. Such orders will be handled as described above. Federal regulations require that verbal requests for additional tests be supported by written documentation. The Clinical Laboratories will request that a new laboratory requisition be submitted whenever we are asked to perform additional tests upon a specimen already in the laboratory. Complete the specimen collection information on the new requisition using the date and time of the specimen given to you by the laboratory when you made your telephone request. Check the appropriate test box or write in the name of the additional test and include the following: "ADD-ON TO SAMPLE ALREADY IN LAB" in the space in the lower right hand corner of the form. Where it is not expedient to wait for the receipt of the written confirmation, the additional tests will be processed in a timely manner to ensure that specimen integrity and quality of patient care are not jeopardized; note that the written request must match the verbal orders.

The laboratory will try to honor requests for STAT add-on tests, however, due to the additional steps required to locate a single specimen and get it to the correct section for testing we cannot guarantee the actual turn-around-time for such a test order. It is generally more efficient in stat situations to collect a new sample for testing.

Reference Laboratory Testing

If a desired test is not listed in the laboratory manual please contact the laboratory at 415-353-1667 and ask to speak to a Laboratory Medicine Resident, Section Director or our send-out staff to inquire if the test is available. Federal CLIA regulations require that we only refer samples for testing to other CLIA (or equivalent) certified laboratories. If the test is available at one of our approved, CLIA certified reference laboratories, it may be ordered in Apex as a Miscellaneous Outside Lab test (MOLT). When ordering a MOLT, please include the exact name of the test and the name of the laboratory to which it will be sent.

Certain send out tests (e.g. genetic testing) may require that a vendor specific requisition be completed by the ordering provider and submitted with the specimen.  Please check the particular reference laboratory’s website for any required forms or contact our send out staff.

As many reference laboratories do not receive specimens over the weekend, please check the test menu information or contact send-out staff for any potential shipping limitations before collecting the specimen.

It is Clinical Laboratory policy that we do not refer testing for non-UCSF patients or research studies.

Research Testing

Discounted laboratory services are available to researchers with grants and/or contracts which have been approved by the UCSF Institutional Review Board (IRB). Tests are given a research price based on a fee schedule, available by calling Adriana Silva, Clinical Labs Administrative Analyst, at x3-1081.

Note: You must obtain a ZZ account (see below) before the clinical labs will process your samples.

Due to Medical Center policy, we cannot forward research samples to reference laboratories for testing. If you desire testing that the clinical laboratory does not perform you will need to arrange this with a reference laboratory directly.

To be eligible for discounted rates, the researcher must contact the Intake Team ([email protected]) for assistance in creating a ZZ research account.

Prices of tests performed in-house are guaranteed for the current fiscal year. Annual increases are usually applied as part of Medical Center-wide charge updates at the beginning of the fiscal year.

Testing of samples from research animals as part of a research protocol is not offered through the UCSF Clinical laboratories. Please contact the Mouse Pathology Core at the Helen Diller Family Comprehensive Cancer Center for assistance: http://cancer.ucsf.edu/research/cores/mouse Ph: 415-514-3500.

For additional information please call Adriana Silva at the Clinical Laboratories office, x3-1081.

Additional information regarding results reporting (including reference/normal ranges that are often required by research study sponsors) can be found here.

To request signed copies of our CLIA Directors' CVs please email Terrina Yamamoto.