The HL7 records are results only. When you do import the lab, they are in a nice format with notes, etc. just like the printed results you are used to. For orders, we print the lab slip from the orders section of AC. We were concerned at first that Quest might demand a patient ID number, but they decided to play nice and accept the form as is. Quest bills our patients directly, so I don't think the account number is a huge deal.
Our Quest collection point is not huge, and they know who we are when a patient comes down with an order. I'd talk to the lab manager, and see if they are not willing to go along with you.
BTW, here is a link to some lab order tips my partner came up with:
http://www.amazingcharts.com/ub/ubbthreads.php/topics/20897/Customizing_order_of_lab_tests#Post20897
