EMR Vendor Initiated Request

Welcome to the EMR Interface request form.

What would you like to do today?

Welcome to the EMR Vendor Initiated request page.Getting started with your client's
Interface request is just a few steps away.

Is the client an existing Quest Diagnostics client? Yes No

Is this a secondary account add-on to an existing Quest Interface? Yes No

Please enter the account number of the Primary site for the completed interface
you would like to add additional accounts to:

Primary Account Number:
Zip Code:

Warning: Accessing health information without proper authorization is a crime, in violation of state and federal laws, including the privacy provisions of HIPAA. Individuals violating HIPAA are subject to criminal and civil penalties, with prison terms of up to 10 years. Civil penalties under HIPAA range up to $1.5 million. If you, or someone on your behalf, submits false information or otherwise inappropriately uses a medical professional's information to set up an account with Quest Diagnostics such that personal health information is improperly accessed your actions will be provided to law enforcement authorities, and you may be prosecuted to the fullest extent of the law.