Get Uw Medicine Pathology Service Request 2013

Filling out the UW Medicine Pathology Service Request form is a straightforward process that ensures accurate specimen handling and billing. This guide provides step-by-step instructions to help you complete the form efficiently and correctly.

Follow the steps to complete your pathology service request

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin with patient information. Fill in the patient's last name, first name, date of birth, and sex. Ensure that the patient's address, phone number, and postal code are correctly entered to facilitate prompt communication.
3. Complete the requesting institution section. Input the institution's name, address, city, state, and postal code. This information helps identify where the request is coming from.
4. Add the information of the person completing the form, including their phone number and fax number. This ensures direct communication for any clarifications.
5. Fill out the details of the requesting physician, including their name, phone number, fax number, and NPI number. Similarly, provide information for the referring physician and referring pathologist.
6. Specify the patient's insurance details in the payment options section. Choose between options like self-pay, institution billing, or split billing for Medicare, and provide corresponding insurance details.
7. In the specimen information section, indicate the medium (slides or blocks) along with the respective quantity. Fill in the date of collection and provide a case type.
8. If applicable, add any additional comments or related history in the provided section. Although this is not required, it can be helpful for context.
9. Finally, the form requires a physician's signature to acknowledge agreement with the laboratory services policies. Ensure the date is also provided.
10. After completing all sections, you can save your changes, download the filled form, print it, or share it as needed.

Complete your UW Medicine Pathology Service Request online now for efficient processing.