New Reference Laboratory (Send Out Test) Request Submission Portal

Selection of Reference Laboratories

Reference laboratories are chosen based upon quality of performance. Specimens must be referred only to a CLIA-certified laboratory or a laboratory meeting equivalent requirements as determined by Center for Medicare and Medicaid Services (CMS). Therefore, all requests for and approval of reference laboratories are required by the CLIA Laboratory Directors of UnityPoint Health - Des Moines Clinical Laboratories and Pathology Laboratory.

The Clinical Laboratory has a process for evaluating new test requests and qualifying reference laboratories to ensure quality of patient care, as well as compliance with accreditation requirements and applicable State/Federal laws including, but not limited to, possession of CLIA certification. New test requests will also be reviewed by the Laboratory Directors and Executive Director for medical necessity, consensus among applicable ordering providers, and cost and reimbursement. The review process for a new reference laboratory (send out test) may take approximately 8-10 weeks. Avoid collecting the specimen until the request has been approved unless previously discussed with the CLIA Laboratory Director (DM-Hospitals: Dr. Larry Anderson, MD or Pathology Laboratory: Dr. Jacob Sramek, MD).

Please contact the Kim Von Ahsen, Laboratory Quality & Safety Specialist at if you have any questions or concerns. Thank you!




UnityPoint - Health Des Moines Laboratories' approved Referral Lab list is available here.

If the performing lab is not listed, please complete the New Performing Lab information below.

Please note that if you choose NEW PERFORMING LAB, specimens can only be sent to laboratories with a CLIA Certificate. This information can typically be found on the laboratory website or by contacting the laboratory.

New Performing Lab Address



Please note that any potential conflicts of interest will be forwarded to the Office of Compliance and may extend the review period for this request. *
Does the requesting provider and/or their family member have a financial interest in the referred lab?
Is the requesting provider and/or their family member receiving remuneration from the referred lab?
Is the requesting provider and/or their family member employed, in any capacity, paid or unpaid, by the referred lab or test manufacturer?
To your knowledge, does any other UPH workforce member(s), or their family member, have a financial interest in the lab being requested?
Did any other UPH workforce member(s) refer you to use the lab being requested?

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