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  • Cancer Type Id Requisition Form

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2009 bioTheranostics Inc. All rights reserved. CLIA 05-D1065725 BIOTHERANOSTICS INC. 11025 ROSELLE STREET SUITE 200 SAN DIEGO CA 92121-1208 TOLL FREE 877 886-6739 CA CLF334843 BTX 0005 12/09 WEB5883. Insurance Carrier Name I hereby request and authorize bioTheranostics Inc. to utilize the above information to process the tumor specimen for the indicated patient. Biotheranostics. com 2. PATIENT INFORMATION 1. ONCOLOGIST INFORMATION Name NPI Email Social Security Number Practice Name DOB Address City State Phone Physician Direct Zip Fax Sex q M q F Medical Record Number Phone Alternate Phone Entering fax certifies fax equipment is located in a secure area. 3. Test Requisition Form THEROS CancerTYPE ID THEROS Breast Cancer Index Toll Free 877 886-6739 Fax 858 587-5888 www. PATHOLOGIST INFORMATION 4. SPECIMEN INFORMATION Block ID Number Biopsy Site Date Collected Date of Discharge or Outpatient Encounter Laboratory Name Fixative Type Sending Hospital/Facility Block Return Address Informati....

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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.

Background: Pathologists use various panels of immunohistochemical (IHC) stains to identify the site of tissue of origin for metastatic tumors, particularly poorly or undifferentiated cancers of unknown or uncertain origin.

Tests on the tissue sample They might use immunohistochemistry (IHC) tests, which look for particular proteins on the surface of the cancer cells. These tests can sometimes tell which type of cell the cancer started in.

CancerTYPE ID is a proprietary molecular cancer classifier used to identify unknown or unclear tumor types and subtypes in patients with metastatic cancer.

A term used to describe the original, or first, tumor in the body. Cancer cells from a primary tumor may spread to other parts of the body and form new, or secondary, tumors. This is called metastasis. These secondary tumors are the same type of cancer as the primary tumor. Also called primary cancer.

To bill for Cancer TYPE ID, please provide the following claim information: CPT code: 81540- Oncology (tumor of unknown origin) mRNA gene expression of 92 genes.

The Tissue of Origin Test (Pathwork® Diagnostics, CA, USA) is a molecular diagnostic test that was developed to assist in the diagnosis of metastatic, poorly differentiated, and undifferentiated cancer. The Tissue of Origin Test is based on an Affymetrix microarray.

(KAN-ser ... UN-none PRY-mayr-ee OR-ih-jin) A case in which cancer cells are found in the body, but the place where the cells first started growing (the origin or primary site) cannot be determined. Also called carcinoma of unknown primary and CUP.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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