Follow the steps to complete the requisition form successfully.

1. Click ‘Get Form’ button to obtain the CA CHLA OncoKids Test Requisition form and open it in an online editor.
2. Complete the patient information section including the last name, first name, middle initial, hospital or laboratory name, and contact name.
3. Fill in the patient's address, date of birth, and gender. Select the appropriate ancestry categories.
4. Provide the city, state, and zip code for the patient, as well as their phone number and fax number.
5. Include the patient's email address and specify if a duplicate report should be sent. Enter the medical record number (MRN) if applicable.
6. In the clinical information section, complete the referring physician's name, address, and NPI (National Provider Identifier).
7. State the clinical diagnosis or indication for the test. Remember to include a copy of the pathology report with the requisition.
8. In the billing information section, provide details of the referring institution and CHLA account number.
9. Complete the sample information fields, including the date and time of collection, as well as the name of the person who collected the sample.
10. Select the sample type from the options given, ensuring to follow the proper guidelines for the type of specimen being submitted.
11. If applicable, fill in details regarding the test order options, including source and percent of tumor in the sample.
12. Finally, review all entered information for accuracy. Save your changes, download, print, or share the completed form as needed.

Ensure the timely processing of your tests by completing your requisition forms online today.