Get Pathology Request Form - Fairview

Filling out the Pathology Request Form - Fairview online is an essential process for ensuring accurate and efficient lab processing. This guide provides clear, detailed steps to help users complete the form effectively.

Follow the steps to complete the Pathology Request Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the account number or purchase order (P/O) in the designated field to identify billing information for the request.
3. Fill in the address section clearly. If available, attach a preprinted label to each copy of the form for ease of identification.
4. Specify the collection date and time. Be sure to format the date as MM/DD/YYYY and provide an exact time for sample collection.
5. In the 'Specimen Information' section, write down the referring physician's name, followed by their contact information including city, state, and zip code.
6. List the performing physician's name along with their contact details, ensuring clarity and accuracy.
7. Provide complete patient data, including their name, date of birth, address, sex, phone number, and Social Security number.
8. Detail the pertinent clinical history. Include an ICD-9 code, diagnosis, or a brief description of symptoms and relevant medical history as required.
9. Indicate the studies requested by checking the relevant options, including surgical pathology or cytology, among others.
10. For billing information, complete all necessary fields including primary and secondary insurance details, plan name, and member IDs in order of payer priority.
11. Once all fields are accurately filled, review the document. You can then save changes, download, print, or share the form as needed.

Complete your pathology request form online today for a seamless lab experience.