Get Pathology Consultation Request - Mcs14572. Pathology Consultation Request - Pathology Consultation

Completing the Pathology Consultation Request - MCS14572 is essential for timely review of your pathology cases. This guide provides clear and supportive instructions to help you accurately fill out the form online.

Follow the steps to complete the Pathology Consultation Request form.

1. Click 'Get Form' button to obtain the form and open it in the designated editor.
2. Enter the patient's social security number, which is required for identification purposes only.
3. Fill in the patient's name, including last name, first name, and middle name.
4. Provide the patient's date of birth in the format mm/dd/yyyy.
5. Select the patient's gender by marking the appropriate box for either male or female.
6. For each case, enter the case number, accession number, specimen source, procedure date, and the number of slides, blocks, or CDs submitted.
7. If there are more than three cases, you will need to fill out an additional form.
8. Enter the referring physician's name, NPI number, and UPIN number.
9. Provide the institution name, mailing address, billing contact, billing phone number, and physician phone number.
10. Indicate the shipping address for where the samples should be sent.
11. Check one option from the list of available MCA consultation services that applies to the case.
12. If additional reports need to be faxed to other physicians, please provide their names and fax numbers.
13. Review all entered information for accuracy before proceeding.
14. Once completed, you can save changes, download, print, or share the form as needed.

Start completing your Pathology Consultation Request form online today!