Get Oncotype Dx Prostate - Genomic Health, Inc.

Completing the Oncotype DX Prostate Order Form and Statement of Medical Necessity is an essential step in evaluating risk for prostate cancer. This guide provides a clear, step-by-step approach to ensure that users can accurately fill out the form online, facilitating a smooth submission process.

Follow the steps to effectively complete the Oncotype DX Prostate order form.

1. Press the ‘Get Form’ button to access the Oncotype DX Prostate order form and open it in the online editor.
2. Fill out the 'Patient Information' section. Enter the patient's full name, date of birth, medical record number, and address. Make sure all fields are completed accurately.
3. Complete the 'Clinical Information' section. This includes entering the pre-biopsy PSA levels, Gleason Score, and other relevant clinical details as required.
4. In the 'Ordering Information' section, provide the practice account name and the names and contact information of any additional physicians or recipients as necessary.
5. Fill out the 'Billing Information' section carefully. Indicate the insurance type, select applicable ICD-10 codes, and make sure to include relevant insurance details. Attach copies of the patient's insurance cards.
6. If applicable, check the box indicating the patient's awareness of their prostate cancer diagnosis, authorizing Genomic Health to make contact for financial purposes.
7. In the 'Specimen Retrieval' section, indicate where the specimen is located, referencing the pathology report if available.
8. Sign and date the form in the 'Physician Signature & Attestation' section, ensuring that the signature is from the ordering physician or their representative.
9. In the 'Pathology Information' section, enter the necessary identification numbers for the specimen and ensure a pathology report is included with your submission.
10. After ensuring all sections are correctly filled, you can save your changes, download the completed form, print it, or share it as needed.

Complete your Oncotype DX Prostate order form online today for an efficient submission process.