Get Brca 1/brca 2 And Bart Testing Medical Review Form

Filling out the BRCA 1/BRCA 2 And BART Testing Medical Review Form online is a crucial step in managing genetic testing for hereditary breast and ovarian cancer. This guide will provide a comprehensive, step-by-step walkthrough to help you complete the form accurately and effectively.

Follow the steps to fill out the form correctly and efficiently.

1. Press the ‘Get Form’ button to access the form and open it in your document manager.
2. Begin with the patient information section. Fill in the patient's name, HealthPartners ID number, and date of birth (DOB). Ensure that all details are accurate to avoid future issues.
3. Proceed to the requester information section. Enter the name of the person completing the form, along with their clinic or facility name, fax number for response, and phone number.
4. Next, provide the physician information. Fill in the physician's name, their Tax ID number, clinic or facility name, and both phone and fax numbers.
5. Complete the billing lab information section by entering the lab name, fax number, Tax ID number, and phone number.
6. In the procedure information section, specify the proposed date of the procedure and input the appropriate ICD 9 code. If undecided, indicate TBD (to be determined) and include a diagnosis.
7. Check all applicable boxes under the genetic testing request section to confirm the tests you are requesting, ensuring they align with the NCCN Guidelines.
8. For patient counseling, include the name of the genetic counselor or medical geneticist, their clinic or facility, fax number, and phone number. Specify the date of counseling and whether summary notes are included with the request.
9. Finally, review all sections for completeness. Ensure required documentation is attached, and then save the changes or proceed to download, print, or share the form as needed.

Take the next step towards managing genetic testing by completing the BRCA 1/BRCA 2 And BART Testing Medical Review Form online today.