I understand my signature Is required for each patient's test order. I understand that it Is my responsibility to determine the medical necessity of tests I have requested for the treatment and/or diagnosis of my patients. I agree to provide diagnosis codes, defined to the highest level of specificity, for each test that I request in order to confirm medical necessity and to enable the laboratory to bill effectively on my patient's behalf. Tests that are deemed medically unnecessary may result in a denial of payment and/or penalties. I understand that the laboratory will be billing third parties for the tests I ordered using CPT codes noted in the Annual Notice to Physicians. In the event that Insurance providers request documentation, I will provide signed written orders from the patient’s medical record to the requesting party within 72 hours.