Get Anser Ifx-adatest Req Ada13046 08142013.indd - Prometheus ...

Filling out the Anser IFX-ADATest Req ADA13046 08142013 form online can seem daunting, but this guide is designed to facilitate the process. Follow these detailed instructions to ensure that all required fields are completed accurately.

Follow the steps to successfully complete the form.

1. Use the ‘Get Form’ button to acquire the form and launch it in your preferred online editor.
2. Begin with the sample collection information. Fill in the DATE COLLECTED and TIME COLLECTED as required. Ensure that the PATIENT ID # and SENDER SAMPLE ID # are also completed.
3. Next, enter the PROVIDER / ACCOUNT INFORMATION. Provide the ACCOUNT NAME / ADDRESS, PHONE, and FAX numbers. Include the PROVIDER / NPI # and the corresponding MEDICARE ONLY - HOSPITAL STATUS when the sample was collected by selecting the appropriate option.
4. List the LABORATORY / OTHER NAME / ADDRESS, along with its PHONE and FAX details. Make sure to also add the ICD-9 CODES which are mandatory.
5. In the PATIENT INFORMATION section, fill out the LAST NAME, FIRST NAME, MI, ADDRESS, APT. NO., CITY, STATE, ZIP, HOME PHONE #, DOB, and SEX. Ensure accuracy to avoid issues later.
6. Indicate the TEST REQUESTED by selecting between PROMETHEUS® Anser™ ADA or PROMETHEUS® Anser™ IFX, including the dosage and frequency as per the patient's needs.
7. Provide the REASON FOR ORDER by choosing the most relevant option pertaining to the patient's condition.
8. Complete the BILLING INFORMATION section by indicating whether the billing is to the provider account, insurance, laboratory, or patient. Attach a copy of the insurance card if applicable.
9. In the ADDITIONAL INFORMATION section, fill in any specifics like prior doses and injection intervals as required.
10. At the end of the form, ensure the ORDERING PROVIDER'S SIGNATURE and PRINT NAME are included along with the DATE to verify the correctness of the test request.
11. Once you have reviewed and are satisfied with the information filled in, you can save changes, download, print, or share the completed form online.

Complete your forms online today to streamline your process.