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Invoice Discrepancy Forms

Have a problem with your invoice? Let us know with this discrepancy form. 

Use this form if you are a new client (nursing home) and wish to begin contracting Seascape Health Allliance to conduct your phlebotomy services.

Requisition Form

Download our lab requisition form here. Please remember that all tests require an ICD-10 code and the medical necessity of each test ordered. If there is reason to beleive that a carrier will not pay for a test, the patient MUST be informed and asked to fill out an Advanced Beneficiary Notice (ABN), which muct be signed by the patient and attached to the requisition form, indicating acceptance of the cost of the requested test.

Supply Request Form

Running out of supplies that we provide? Use this if you are running low on sterile containers, culturettes, biohazard bags, 24-hour urine containers, lab books, lab forms and more. Orders for lab forms may take up to 10 days to fill.

Download and print extra sheets for your lab log.

Fill out this Advanced Beneficiary Notice form if Medicare or private payers will not pay for a requested test. This form must be attached to the Requisition Form.

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