Get Diagnostic Hiv Requisition - Wadsworth Center - Wadsworth

This guide provides clear instructions on how to effectively fill out the Diagnostic HIV Requisition Form for testing at the Wadsworth Center. Follow these steps to ensure that all necessary information is accurately submitted to facilitate proper testing and reporting.

Follow the steps to complete the requisition form successfully.

1. Press ‘Get Form’ to access the Diagnostic HIV Requisition and open it for editing.
2. Identify the test requested by checking the appropriate box in Section 1. Specify if you are requesting HIV testing, HCV testing, or other tests as needed.
3. For anonymous HIV testing, enter a patient code and general location details such as county and ZIP code in Section 2. Ensure no identifying information is included.
4. In Section 3, if not using anonymous testing, enter the patient's first name, last name, middle initial, street address, city, and state.
5. Complete Section 4 with patient demographics, including gender, date of birth, and racial/ethnic background. Indicate if the patient is a recent immigrant.
6. Fill out Section 5 for specimen information. Specify the specimen type and collection details, including address, collection date, and time.
7. In Section 6, provide any previous HIV test data or other relevant clinical history regarding prior tests or vaccination trials.
8. Complete Section 7 with any HCV test data, if applicable, including queries regarding previous test confirmations.
9. Use Section 8 to add any additional comments that may aid in testing or reporting.
10. Finally, complete Section 9 with submitter information including name, license number, facility details, and contact information to ensure proper transmission of the laboratory report.
11. After completing all sections, review the form for accuracy, then save your changes. You may now download, print, or share the completed form as necessary.

Complete your document submissions online today to facilitate timely testing.