Get Harmony Test Requisition Form (for Gamma Dynacare Canada ...

This guide provides step-by-step instructions to help you accurately fill out the Harmony Test Requisition Form. Understanding each section and field will ensure a smooth submission process.

Follow the steps to complete your form accurately.

1. Press the ‘Get Form’ button to access the form and open it for completion.
2. Enter the patient information in the designated fields, including first name, last name, gender, and health insurance number. Ensure that the patient's weight and height are recorded in the correct units (kg and cm, respectively).
3. Fill in the clinic information, such as the clinic name, street address, city, province, country, postal code, phone, and fax numbers.
4. In the patient consent section, confirm the patient's full understanding of the test process. The patient should sign and date this section to provide their authorization for specimen collection and testing.
5. Clinicians must complete their section, attesting that the patient has been informed about the test. They should sign and date the form.
6. Provide the required test information by checking the appropriate options for the Harmony Prenatal Test and any additional analyses, as well as noting the gestational age and drawing date.
7. Indicate whether this is a redraw and record the patient's birthdate. Confirm the number of fetuses and any details related to IVF as applicable.
8. Once all relevant fields are filled, review the form for accuracy. Users can save changes, download, print, or share the form as needed.

Complete your Harmony Test Requisition Form online today for efficient submission.