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Get Cigna Genetic Testing Recommendation Form 2016
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How to fill out the Cigna Genetic Testing Recommendation Form online
Filling out the Cigna Genetic Testing Recommendation Form is an essential step in ensuring proper genetic testing and evaluation. This guide will provide you with clear instructions to navigate the form effectively, enabling you to submit your request confidently.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to obtain the Cigna Genetic Testing Recommendation Form and open it in your preferred editor.
- Begin by entering the customer (patient) information, including their name, Cigna customer ID, date of birth, and the date of consultation.
- Next, provide details about the ordering health care professional. Include their name, taxpayer identification number (TIN), street address, telephone number, city, state, and ZIP code, as well as their fax number.
- If applicable, enter information concerning the clinical geneticist, genetic counselor, or advanced genetics nurse. This section should include their name, street address, telephone number, city, state, ZIP code, and fax number.
- Fill out the rendering laboratory information, providing the laboratory name, taxpayer identification number (TIN), street address, telephone number, city, state, ZIP code, and fax number.
- List the necessary diagnosis codes by entering the appropriate ICD-10 codes in the designated space.
- Input the requested test information, specifying the test name(s) and corresponding CPT/HCPCS code(s).
- Select one of the recommendations from the options provided to indicate the professional's stance on the testing request, and provide explanations where necessary.
- Acknowledge the professional qualifications by checking the appropriate box affirming their credentials and that they are not employed by a genetic testing laboratory.
- Confirm the attachment of the required documentation by checking the relevant box, ensuring that you include the three-generation pedigree, laboratory requisition form, and genetics evaluation documentation.
- Provide your signature and date below to finalize the form. Ensure all information is accurate before submitting.
- After reviewing all completed fields, save changes, download, print, or share the finished form as needed.
Complete the Cigna Genetic Testing Recommendation Form online today to ensure your genetic testing needs are addressed properly.
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To ask for genetic testing, schedule an appointment with your healthcare provider. Discuss your medical history and any concerns you have that may warrant testing. Your provider will then assist you in completing the Cigna Genetic Testing Recommendation Form, ensuring that your request is well-supported and presented effectively.
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