Get Quantiferon Gold Requistion

This guide provides clear instructions on how to complete the Quantiferon Gold Requisition form online. Filling out this form accurately is essential for testing, so please follow the steps carefully.

Follow the steps to complete your Quantiferon Gold Requisition form online.

1. Press the ‘Get Form’ button to download the Quantiferon Gold Requisition form and open it in the appropriate software.
2. Begin by entering the patient's information. Fill in the patient's name (last and first), date of birth (mm/dd/yyyy), age, sex, and confirm the state and county of origin, along with the patient's ZIP code.
3. Provide the patient ID number if applicable. Select the ethnicity and race of the patient from the provided options, ensuring accuracy in your selections.
4. Next, complete the provider information section. Enter the provider code, and if not known, contact the lab to obtain it. Record the name of the physician, provider phone number, provider email, and secure fax number if required.
5. Document the specimen collection date and time by entering the date in the designated format (mm/dd/yy). Choose the specimen source/site from the options provided, and be as specific as possible.
6. Select the appropriate tests based on the specimen and patient requirements, including bacteriology/tuberculosis tests, immunology/virology tests, and any bioterrorism tests as necessary. Mark 'Other' if applicable and specify.
7. Fill in any additional information that may be relevant, including the disease suspected and any known exposures, and provide comments as needed.
8. Finally, review all entries for accuracy. Once the form is complete, you can save your changes, download, print, or share the filled form as needed.

Complete your documents online with confidence.