Get Baylor Genetics Custom Family Sequencing Requesting 2018

Filling out the Baylor Genetics Custom Family Sequencing Requesting form online is a vital step in initiating genetic testing for your family. This guide provides clear instructions for each section of the form to ensure that you provide all the necessary information accurately and efficiently.

Follow the steps to complete your Custom Family Sequencing Requesting form.

1. Click ‘Get Form’ button to receive the form and open it in your preferred editor.
2. Begin with the patient information section. Complete the required fields, including the patient's last name, first name, middle initial, date of birth, biological sex, and contact details. Ensure you enter accurate information as this will be used for the testing process.
3. Fill in the reporting recipients section. Input the name of the ordering physician, as well as the institution name, email address (required for international clients), and contact phone and fax numbers where relevant.
4. In the additional recipients section, provide details of any other people who should receive the test results. Include their names, emails, and fax numbers accordingly.
5. Proceed to the payment options. Select one of the options to indicate how the payment will be processed: self-payment, billing to the patient, or institutional billing. If institutional billing is selected, include the necessary institution details.
6. When entering insurance information, provide a copy of the front and back of the insurance card(s). List the ICD10 diagnosis code(s) along with the name of the ordering physician and the insured's signature of authorization.
7. For the statement of medical necessity, the ordering physician must confirm the necessity for the test and provide their printed name, signature, and date. This step ensures that the test is authorized under medical standards.
8. Fill in the ethnicity section by selecting the appropriate categories that apply to the patient. This information helps in understanding genetic predispositions.
9. Complete the sample information section, specifying the type of sample being submitted (e.g., blood, saliva, DNA) and the date of collection.
10. Detail the custom family sequencing information, including the relationship of the first patient studied and the Baylor Genetics lab number, followed by any required attachments, such as previous results or pedigree charts.
11. Select the relevant test codes for the custom family sequencing tests based on the genes being ordered. Each code corresponds to a specific gene; ensure accuracy in your selections.
12. Review all the information entered into the form for completeness and accuracy. Once confirmed, save changes, download, print, or share the completed form as required.

Complete your Baylor Genetics Custom Family Sequencing Requesting form online today to begin the testing process.