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  • Test Requisition Form - Biotheranostics

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To request the specimen from Pathology (Please complete and fax this form to (858) 587-5874). ORDERING PHYSICIAN PATHOLOGY INFORMATION Name NPI Name NPI Email Email Practice Name Submitting Hospital/Laboratory Name Address Address City State Phone Zip City Fax State Phone Fax Entering fax # certifies fax equipment is located in a secure area. PATIENT INFORMATION Zip Entering fax # certifies fax equipment is located in a secure area. SPECIMEN INFORMATION Name DOB Socia.

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The test requisition combines patient registration information, billing information, specimen information, barcoded specimen labels and a provider order for confirmation of testing.

The Breast Cancer Index test, made by Biotheranostics, analyzes the activity of 11 genes to help predict the risk of early-stage, hormone-receptor-positive breast cancer coming back 5 to 10 years after diagnosis.

Breast Cancer Index (BCI) is a test that provides information to help women diagnosed with early-stage, hormone receptor-positive (HR+) breast cancer, and their oncologists make personalized decisions about extending anti-estrogen (also called hormonal or endocrine) therapy beyond 5 years.

Medicare covers Breast Cancer Indexâ„¢ at a predetermined rate with no fees charged to your patients. Subject to specific coverage criteria. Her commercial insurance plan may cover Breast Cancer Index.

CancerTYPE ID® Performance CancerTYPE ID® is a proprietary molecular assay using RT-PCR to measure expression of 92 genes. To classify the tumor, the gene expression profile is matched to a database of more than 2000 known tumor types and subtypes.

BCI was categorized into three levels: low-risk BCI <5, intermediate risk 5 ≤ BCI < 6.4, and high-risk BCI ≥6.4 [13].

The Breast Cancer Index test analyzes the activity of 11 genes to help predict the risk of early-stage, hormone-receptor-positive breast cancer coming back 5 to 10 years after diagnosis.

Three of the most important markers are estrogen receptor (ER), progesterone receptor (PR) and a receptor called HER2. The levels of these markers can influence how a person with breast cancer is treated in the clinic.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232