Get Karyotype Request Form - Mclendon Clinical Laboratories - Labs Unchealthcare

Filling out the Karyotype Request Form for McLendon Clinical Laboratories is an essential step in accessing appropriate genetic testing services. This guide provides clear instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the Karyotype Request Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the medical record number for the patient in the designated field.
3. Fill in the patient's full name, ensuring correct spelling and formatting.
4. Provide the patient’s date of birth to verify their identity.
5. Indicate the attending physician who is requesting the study.
6. Specify the patient’s sex as per the options provided.
7. Input the social security number of the patient, if available.
8. Complete the address, including city, state, and zip code. This information is necessary for communication purposes.
9. Add the home telephone number for the patient or guardian to facilitate contact.
10. If applicable, include the office address of the attending physician.
11. Record the date and time of the request.
12. Select the specimen type that has been collected for testing.
13. Indicate where copies of the report should be sent for further review.
14. If the patient is a baby boy or girl, fill out the additional requested information including the mother’s name and date of birth.
15. Answer the clinical data questions regarding the patient’s health condition, including whether they are infectious or pregnant.
16. Detail the indication for the study by choosing relevant clinical features or family history.
17. Select the type of study request relating to karyotype and/or microarray.
18. Provide any previous karyotype results and details of where and when they were performed.
19. Indicate any specific fluorescence in situ hybridization studies being requested.
20. Ensure authorization for conducting tests is provided by signing the form where indicated.
21. Date the signature to confirm the request is current.
22. Review all entered information for accuracy before proceeding to save, download, print, or share the completed form.

Complete your Karyotype Request Form online today to ensure prompt processing of your genetic testing needs.