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Get Labcorp Requisition Form
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How to fill out the Labcorp Requisition Form online
The Labcorp Requisition Form is an essential document required for various genetic tests, screenings, and diagnostics. Completing this form accurately online ensures that your medical needs are met without delay.
Follow the steps to fill out the Labcorp Requisition Form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the patient's information in the designated fields. Fill in their full name, date of birth, and contact numbers. Ensure that you select their gender appropriately.
- Provide the address details, including city, state, and zip code. Also include the lab number if available, as well as the hospital number.
- In the referring physician section, print the physician's name and include their signature. Add the NPI number and the date when the blood was drawn, along with confirming whether the patient is pregnant.
- Select the specimen type from the specified options, ensuring only one box is checked. Indicate the ethnicities applicable to the patient by checking all that apply.
- For genetic testing, check the tests that are relevant to the patient. If opting for Ashkenazi Jewish carrier tests, ensure to check the relevant box.
- Fill out the clinical information regarding maternal serum/plasma screening. This includes gravida, para, any previous pregnancies, as well as relevant ultrasound and maternal weights.
- Complete the billing information section by mentioning the insurance company name, policy number, group number, and the relation to the insured individual.
- Finally, obtain the patient’s signature in the designated area, confirming their consent for the tests ordered and their understanding of the associated information.
- After filling in all the necessary details, review the form for accuracy. Users can then save changes, download, print, or share the completed Labcorp Requisition Form.
Complete the Labcorp Requisition Form online today to ensure your testing needs are addressed promptly.
Making a requisition form is easy, especially with online tools like US Legal Forms. You can choose a template and fill it with relevant information, such as patient details and requested tests. After completing the form, you can print it out. This method saves time and helps ensure all required information is accurately captured.
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