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Get Wi Cologuard Form Frm-3004-05-c 2019-2025
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How to fill out the WI Cologuard Form FRM-3004-05-c online
Filling out the WI Cologuard Form FRM-3004-05-c online is a straightforward process that ensures you provide all necessary information for the stool-based DNA test. This guide will walk you through each step, ensuring you complete the form accurately and efficiently.
Follow the steps to successfully complete the online form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill in the provider and order information. Ensure you type all necessary details, including healthcare organization name, provider name, and ICD-10 codes that pertain to the test.
- Complete the certification section by confirming your status as a licensed healthcare provider. Fill in your city, state, zip, and phone number. Note that to receive results, a secure fax number should be provided.
- Next, enter the patient demographics. Include the patient ID/MRN, first name, last name, date of birth, and contact numbers. If applicable, provide the patient’s language preference.
- Fill in the shipping and billing address as necessary, indicating if the shipping address is the same as the billing address.
- Optionally complete the patient ethnicity and race section, marking if the patient is of Hispanic or Latino origin and selecting any applicable race categories.
- Provide patient insurance and billing information, including policyholder details and insurance carrier. Make sure to state whether the patient would like Exact Sciences to bill their insurance.
- In the authorization section, ensure the patient signs and dates the form to authorize billing and confirm financial responsibilities.
- Once all sections are completed, save the form. You can then download, print, or share the final document as needed.
Complete the WI Cologuard Form FRM-3004-05-c online today to ensure timely processing of your test.
Unfortunately, you cannot obtain Cologuard without a doctor’s order. A qualified healthcare provider must assess your health status and determine the appropriateness of the test. This ensures you receive the best care. To proceed, make an appointment with your healthcare provider and request the WI Cologuard Form FRM-3004-05-c to facilitate the process.
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