Get Prometheus Test Requisition/sample Collection (new York Only)

Filling out the Prometheus Test Requisition/Sample Collection form online is a straightforward process that ensures accurate testing for patients. This guide will walk you through each section of the form to help you complete it efficiently.

Follow the steps to fill out the form accurately.

1. Click 'Get Form' button to access the Prometheus Test Requisition/Sample Collection form.
2. Begin by filling out the provider information at the top of the form. Include the account name, address, and contact numbers.
3. In the laboratory information section, input the date and time the sample was collected, along with the physician's NPI number and telephone details.
4. Complete the patient information section by providing the patient's last name, first name, middle initial, address, phone numbers, date of birth, sex, and social security number if applicable.
5. Select the appropriate tests to be performed by checking the corresponding boxes for Prometheus testing.
6. Fill out the billing information section. Include primary and secondary insurance details, along with parent or guardian information if the patient is under 18.
7. Review the acknowledgment of informed consent for genetic testing. Ensure you understand and have the necessary consent from the patient.
8. Finally, save your changes to the form. You may also print it, download it for future reference, or share it as needed.

Complete and submit your documents online for effective processing.