Get Prolaris Form

The Prolaris Form is essential for requesting a biopsy test related to prostate cancer. Filling out this form accurately and completely is crucial for ensuring timely processing and appropriate care for the patient.

Follow the steps to fill out the Prolaris Form online.

1. Click ‘Get Form’ button to obtain the Prolaris Form and open it in the available editor.
2. Provide the patient information in the designated fields, including the patient's name, date of birth, and Social Security Number.
3. Fill in the ordering physician's details, including their name, degree, and NPI number.
4. Complete the clinical information section with relevant details about the prostate cancer diagnosis, including age at diagnosis and biopsy data.
5. Indicate the planned treatment options by checking the appropriate boxes. If applicable, provide additional details in the space provided.
6. For specimen retrieval, specify if you would like Myriad Genetic Laboratories to request the specimen and provide the necessary contact information.
7. The authorized signature section must be completed by the healthcare provider, confirming the need for the test and consent requirements.
8. Select the billing/payment option that applies, providing necessary details and documentation as required.
9. Review all filled fields for completeness and accuracy before proceeding to save changes, download, print, or share the completed form.

Complete the Prolaris Form online to ensure accurate test requests and timely patient care.