Get Cd4 Laboratory Form

Filling out the Cd4 Laboratory Form online is a crucial step in ensuring accurate and efficient reporting of HIV and CD4 laboratory results. This guide will provide you with clear instructions on how to complete each section of the form with confidence.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the Lab Accession number in the designated field. This unique identifier helps track the sample throughout the testing process.
3. Fill in the Medical Record number if available. This number keeps your medical history organized and linked to the test results.
4. Provide the patient's name by entering their first name, last name, and middle initial in the corresponding fields.
5. Complete the Patient Address section carefully, including street address, apartment number (if applicable), city, state, and ZIP code. Ensure this information is legible for proper identification.
6. Select the patient's sex from the options provided, using 1 for Male, 2 for Female, or 9 for Not specified.
7. Input the last four digits of the patient’s Social Security Number (SSN) in the designated field.
8. Enter the patient's date of birth in the MMDDYYYY format to ensure accuracy.
9. Indicate the patient’s ethnicity by checking the appropriate box: Hispanic, Not Hispanic, or Unknown.
10. In the Race section, check all that apply from the list provided, such as American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, Asian, Black or African American, White, or Unknown.
11. Provide the specimen collection date in MM/DD/YYYY format.
12. Select the specimen type by marking the appropriate option (e.g., Blood, Plasma, Serum, Urine, Oral Fluid, Other).
13. Fill in the TEST PERFORMED/RESULT section, indicating whether the result is for HIV-1 or HIV-2 and providing any additional results as needed.
14. If applicable, detail the HIV resistance testing type as specified in the provided options.
15. Complete the ORDERING PHYSICIAN section, including the physician's name, phone number, and facility code.
16. Fill in the testing laboratory section by indicating if the specimen is forwarded to a reference laboratory, and include the CLIA number.
17. Finally, enter the date the form is completed and the name of the person completing the form.
18. Review the filled-out form for any errors or omissions before saving your changes. You can then download, print, or share the form as needed.

Start filling out the Cd4 Laboratory Form online today for seamless reporting!