Get Ucla Immunogenetics Center

Completing the Ucla Immunogenetics Center requisition form is essential for accurate specimen processing and testing. This guide provides a step-by-step approach to ensure that users can effectively fill out the form online.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the requisition form and open it in your online document editor.
2. Fill in the patient or donor information. Input the full name in the designated fields for last, first, and middle names. Enter the UIC number, patient or donor ID, social security number, date of birth, center number, ethnicity, and sex.
3. Provide specimen information. Include the appropriate ICD-9 code that specifies the medical necessity for the requested tests. Enter the physician's name, signature, address, phone number, and ID number.
4. Indicate the type of specimen you are submitting by selecting the correct options for blood, lymph node, or spleen. Fill in the collection date and time.
5. Specify the billing information. Note that billing will not be directed towards individuals or insurance. Provide details on where the bill should be sent.
6. Fill in the results section with the urgent request information, including the physician or client’s name and fax number for results.
7. Complete the patient information history by checking the appropriate box for either patient or donor. Specify blood group and transplant type as applicable.
8. Fill out the section providing details if the enclosed sample is from a donor. Indicate the disease, recipient's name, and last transfusion date.
9. Choose the molecular typing options based on the requirements. Ensure that all necessary selections are made to reflect what is needed for the testing.
10. Conclude by reviewing all entries for accuracy. Save any changes, and utilize options to download, print, or share the completed requisition form as necessary.

Complete your document online now for streamlined processing.