Get Illumina Clinical Services Laboratory Trugenom Technical Sequence Data Test Requisition Form
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How to fill out the Illumina Clinical Services Laboratory TruGenome Technical Sequence Data Test Requisition Form online
Filling out the Illumina Clinical Services Laboratory TruGenome Technical Sequence Data Test Requisition Form is an essential step for submitting a sample for whole-genome sequencing. This guide provides clear instructions to assist users in navigating the form with ease.
Follow the steps to successfully complete the requisition form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Start by filling out Section 1: Requested Test. Indicate the test type by selecting 'TruGenome Technical Sequence Data—Individual Genome Sequence' and ensure you are aware of the standard turnaround time.
- Proceed to Section 2: Physician and Institution Information. Here, provide the authorized physician's name, NPI number or license number, email address for results, phone number, and institution name. Include the institution's address and ensure it's complete for return of results.
- Sign and date all necessary certifications confirming that informed consent has been obtained, compliance with the laboratory's data use terms, and that the ordering physician is properly licensed.
- In Section 3: Patient Information, enter the patient’s first and last name, date of birth, middle initial, and sex. Additionally, provide ethnic identifiers if applicable and ICD-10 codes. Input any relevant IRB institution information and IRB protocol number.
- For Section 4: Blood Collection Information, indicate the date the sample was obtained and confirm that the sample type is blood in a collection tube.
- Complete Section 5: Billing Information by selecting a payment method and entering the required details. This includes name and address of the responsible party, phone number, and email. Make sure to acknowledge financial responsibility.
- Finally, review and save the completed form. You may choose to download, print, or share the form as needed. Ensure all signatures are collected and the patient informed consent form is signed before submission.
Complete your form online to ensure a smooth submission for sequencing.
The Illumina file format encompasses several types, including BCL, FASTQ, and VCF formats, which support a wide range of genomic applications. These formats allow for detailed reporting, data sharing, and further analysis. By utilizing the Illumina Clinical Services Laboratory TruGenom Technical Sequence Data Test Requisition Form, you can receive your data in the formats that best suit your research needs.