Get Test Requisition Form - Hematologics Inc.

Filling out the Test Requisition Form for Hematologics Inc. can be a straightforward process when approached step by step. This guide provides clear instructions for each section of the form to ensure you complete it accurately and efficiently.

Follow the steps to complete your form effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin filling out the patient information section by providing the patient's name, HLID number, date of birth (DOB), age, and gender. This information is crucial for identifying the patient.
3. In the specimen information section, specify the type of specimen collected by ticking the appropriate box. Enter the specimen collection date and time.
4. Provide patient history and treatment status. If a complete blood count (CBC) is available, attach it for reference.
5. Select the relevant tests requested, ensuring you tick all applicable boxes for flow cytometry, molecular studies, cytogenetics, or FISH panels. If additional options are needed, specify them in the provided fields.
6. Enter the ordering physician’s name and NPI number along with their contact phone number. Include clinic information as required.
7. At the end of the form, specify how you would like the results reported by filling in the necessary details for fax or phone results.

Complete your Test Requisition Form online for a streamlined process.