Hmm. Here a clinician (or reg, resident or intern under a clinician) must sign the request (either electronically or on paper) because of Medicare billing - a doctor with a provider number must request a test for that test to be billed back to Medicare by the pathology service. I think (not sure, but I think) that private health insurers use the same requirement - easier than re-creating the wheel for themselves. Tests performed in the lab are covered by a declaration on most requests which says something along the lines of the clinician assigning rights to the pathologist to perform tests as necessary (so...my Ab screen is positive, guess I'd better run a panel...LUCKY!) "as defined by laboratory procedure". If memory serves. I've only read it on requests a million times. The only time it causes a lot of drama here is when a doctor wants an add on and doesn't see why they need to fill in the paperwork - the rules say 14 days to chase up an appropriately signed request, or Medicare will not pay - in general pathology it's a golden rule that no paperwork, no test. Of course, what usually happens is the tech will run the test (it's usually a fibrinogen on a bleeding patient, natch, would you like some cryoprecipitate with your order?) and put nothing in the LIS until the request is received. Blood Banks are a little different. In one health service, no paperwork, no crossmatchee with limited use of phone requests (or billing throws a major spit). In another, phone requests are the only way product orders are placed - beyond the original signed group and hold. Medicare rules say fourteen days, sure, but NPAAC guidelines say that a phone request is acceptable, since a group and hold is collected and requested in the expectation of the requirement of products. I don't think it's ever gone to court...could be interesting as to whose cojones would win that fight.