Get Biopsy Request Form

Filling out the Biopsy Request Form online is an essential process for ensuring accurate communication regarding muscle biopsy analysis. This guide will provide you with clear, step-by-step instructions to help you complete the form efficiently.

Follow the steps to complete the Biopsy Request Form online.

1. Press the ‘Get Form’ button to access the Biopsy Request Form and open it in your preferred online editor.
2. Begin by entering the patient information at the top of the form. Fill in the patient's name, address, date of birth, and gender. Ensure you also include the date and time of the biopsy, as well as the tissue source.
3. For studies requested, indicate the required tests by checking the appropriate boxes. Include histochemical/enzyme studies by completing the section for all muscle biopsies, and select one for electron microscopy studies if applicable.
4. Provide details on the clinical diagnosis, brief history of illness, relevant family history, present medications, and physical and neurological examination findings. Be thorough and clear in this section to assist the laboratory team.
5. Next, document the EMG findings and current and previous CPK levels, as well as any other pertinent information that is relevant to the biopsy.
6. In the billing information section, select the appropriate billing option: either the hospital/clinic or medical assistance/Medicare. If the latter, ensure to attach a copy of the insurance card.
7. Fill in the requesting physician’s information, including name, address, telephone, and fax number to ensure quick correspondence.
8. Indicate the recipients for the report copies in the designated section, making sure to include names and addresses clearly.
9. Finally, provide the name and telephone number of the person completing the form. Review all entries for accuracy before saving.
10. Once completed, save changes, and choose to download, print, or share the Biopsy Request Form as necessary.

Start filling out your Biopsy Request Form online today for a smoother documentation process.