Get Bone Marrow Request Form - Bc Cancer Agency - Bccancer Bc

Filling out the Bone Marrow Request Form is a critical step in ensuring that patients receive the necessary care and procedures they require. This guide will walk you through each section of the form, providing clear, step-by-step instructions to help you complete it accurately and efficiently.

Follow the steps to complete the Bone Marrow Request Form online.

1. Press the ‘Get Form’ button to access the Bone Marrow Request Form and open it for editing.
2. Begin by entering the patient’s name in the format of last name followed by first name. Ensure this is legible as it is vital for identification.
3. Next, fill in the patient's Personal Health Number (PHN) to help track their medical records.
4. Indicate the patient's date of birth using the format day/month/year.
5. Select the patient's sex by marking 'M' for male or 'F' for female.
6. Specify if the patient is a BCCA patient by selecting Yes or No.
7. If applicable, input the expiry date of the patient’s information in the format month/year.
8. Fill in the name of the requesting physician along with their Medical Services Commission (MSC) number.
9. Enter the physician's address and phone number for follow-up purposes.
10. Indicate if there is an infectious hazard by selecting Yes or No, and specify details if necessary.
11. Input the BCCA number and staging information, marking Yes or No as appropriate.
12. Provide clinical history and any specific clinical requests for tests, clearly marking the checkbox for tests required such as Cytogenetics or Biopsy.
13. Specify the doctor who will perform the procedure, along with the planned biopsy date and time (select from provided times).
14. Finalize the form by faxing it to the specified number and sending the original to the BCCA Diagnostic Cytology Laboratory.
15. After completing the form, save changes, and if needed, download, print or share it.

Complete your Bone Marrow Request Form online today for efficient processing.