Get Quest Diagnostics Authorization Form

This guide provides a clear and comprehensive approach to filling out the Quest Diagnostics Authorization Form online. Follow these instructions to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the form correctly

1. Click ‘Get Form’ button to obtain the Quest Diagnostics Authorization Form and open it in the editor.
2. In the patient information section, provide the required details, including the patient’s name, date of birth, and social security number.
3. If applicable, fill in the ordering physician’s name or practice name. Ensure to include gender, address, and any additional required information.
4. Review the section regarding the purpose of the authorization and ensure you understand how your Protected Health Information (PHI) will be used and disclosed.
5. Sign the authorization section, either as the patient or a representative, including the date.
6. If you wish to revoke the authorization, fill out the revocation section and sign it. Otherwise, your authorization will remain valid until the specified expiration date.
7. Once all fields are filled out correctly, save your changes. You can download, print, or share the completed form as needed.

Complete your documentation promptly and efficiently by filling out the Quest Diagnostics Authorization Form online.