Get Brcassuresm Test Requisition Male - Labcorp

Completing the BRCAssureSM TEST REQUISITION for males is an essential step in genetic testing for hereditary breast and ovarian cancer. This guide provides clear, step-by-step instructions to help users navigate the form with ease and confidence.

Follow the steps to expertly complete the form.

1. Click ‘Get Form’ button to obtain the BRCAssureSM TEST REQUISITION Male - LabCorp form and open it for editing.
2. Begin with the patient information section. Fill in the required fields, including the patient's last name, first name, middle initial, date of birth (format: MM/DD/YYYY), and contact numbers. Be sure to provide the complete address including city, state, and zip code.
3. In the client information area, confirm that the patient has been informed about the testing. Provide the referring physician's printed name, authorized signature, and their NPI and taxonomy numbers.
4. Specify the specimen type, which is usually peripheral blood, and provide a diagnosis using the ICD-CM format, ensuring to include the highest specificity required.
5. Check all applicable ethnicities from the listed options. Providing accurate ethnic background information helps ensure the reliability of test results.
6. Indicate whether genetic counseling was provided by selecting 'Yes' or 'No,' and if applicable, provide the name of the counselor.
7. Select the desired BRCAssureSM test from the options available and confirm if the patient meets the NCCN criteria for BRCA1/2 testing.
8. Fill out the patient clinical history section to indicate prior cancer conditions, if applicable. Provide necessary details regarding any previous test results.
9. Obtain the patient's signature on the informed consent section, indicating their understanding and authorization of the tests requested.
10. Finally, review all entered information for accuracy before proceeding to options to save changes, download, print, or share the completed form.

Complete your BRCAssureSM TEST REQUISITION Male - LabCorp form online for accurate genetic testing and support.