Get Baycare Laboratories Home Draw Request Form Fax 727 - Baycare

This guide provides comprehensive, step-by-step instructions for users to effectively fill out the BAYCARE LABORATORIES Home Draw Request Form online. By following these instructions, you will ensure your form is completed accurately and submitted appropriately.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to obtain the BAYCARE LABORATORIES Home Draw Request Form and open it in your preferred editor.
2. Fill out the account information section. Begin by entering the person's name requesting the service as well as their office and phone number. Provide the ordering physician's name, address, and phone number.
3. Indicate whether to call the results to the physician or fax them by selecting 'Yes' or 'No' for both options.
4. For billing information, specify the payment method (Insurance, Medicare B, Medicaid, or Self Pay), and include the insurance company name, group number, date of birth (DOB), social security number (SSN), sex, phone number, and address.
5. In the tests section, mark the required tests by checking the appropriate boxes. Include individual tests as necessary and provide a diagnosis code, as it is required.
6. Complete the ordering priority section by selecting the applicable option: Routine, Timed Collection, Standing Order, or STAT.
7. Fill in the collection day and date, and if applicable, provide frequency and start/end dates for standing orders.
8. Confirm the definition of 'homebound' status by ensuring that the ordering medical professional completes this section, including their signature and date.
9. Once all fields are completed, review the form for accuracy. Save any changes made to the document. You may print the form, download it, or share it as needed for submission.

Start completing your BAYCARE LABORATORIES Home Draw Request Form online today.