How to Refer a Patient

Complete the Therapeutic Phlebotomy Physician Order Form in full, including diagnosis, prescribed volume, frequency, and any hold parameters or special instructions.

📠 Fax completed orders to: 702-993-4866

All orders are reviewed by clinical staff prior to patient scheduling.

1. Provider order is reviewed for completeness
2. Provider is contacted if clarification is required
3. Patient is contacted to schedule services
4. Therapeutic phlebotomy is performed per provider order
5. Documentation is maintained in accordance with facility protocols

• Therapeutic phlebotomy is a medical treatment performed only with a valid, signed provider order. Blood removed during therapeutic phlebotomy is not used for transfusion.
• General phlebotomy and specialty kit collections are performed for diagnostic or monitoring purposes and require a valid provider order or patient-authorized testing, as applicable.
• Specialty kits (including but not limited to reference lab, specialty lab, and wellness kits) must be accompanied by complete requisition forms and all required materials at the time of collection.
• All orders must be signed and dated by a licensed provider prior to scheduling. Incomplete or illegible orders may delay services.
• Patients are required to complete a general consent form prior to specimen collection. Consent may be obtained at the time of service if not submitted in advance.
• Specimens are collected by trained clinical staff in accordance with established protocols, chain-of-custody requirements (when applicable), and facility SOPs.
• Collected specimens are processed and handled according to the ordering provider’s instructions and the requirements of the receiving laboratory.
• Clear Code Testing provides specimen collection services only unless otherwise specified. Test interpretation, diagnosis, and treatment decisions remain the responsibility of the ordering provider.

For questions regarding referrals, specialty kit requirements, or scheduling, please contact our office prior to submitting orders.