Get Cytogenetics Requisition - Tricore Reference Laboratories - Tricore

Filling out the Cytogenetics Requisition form for TriCore Reference Laboratories is a vital step in facilitating accurate genetic testing. This guide provides a detailed, user-friendly walkthrough of the form to ensure all necessary information is captured correctly.

Follow the steps to fill out the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the Cytogenetics Requisition form and open it in your preferred document editor.
2. Begin by entering the patient’s name in the designated fields: Last Name, First Name, and Middle Initial.
3. Fill in the Patient ID field, along with the date of birth, ensuring the correct format is used.
4. Indicate the patient's sex by selecting either 'M' for Male or 'F' for Female.
5. In the Ordering Physician section, provide the full name of the physician who is ordering the test.
6. Indicate whether fasting is required by selecting 'Yes' or 'No'.
7. If there are any comments or specific instructions regarding additional copies of the report, include them in the comments section.
8. Complete the mailing address section for the report, including city, state, and ZIP code.
9. Record the patient phone number and Social Security number in the appropriate fields.
10. Fill out the date and time the sample was collected, specifying AM or PM.
11. For insurance information, include the responsible party’s details if the patient is a minor. Fill in the insurance address and member ID number.
12. In the Diagnosis/Indications for Chromosome Testing section, provide relevant information about the tests requested.
13. Select the appropriate tests requested from the list provided, ensuring to specify any critical tests that need urgent attention.
14. Complete the informed consent declaration section, ensuring the patient or guardian provides their signature.
15. Review the completed form for accuracy and clarity.
16. Once complete, save any changes made to the form, and choose to download, print, or share the completed requisition as needed.

Start completing your Cytogenetics Requisition form online today!