Get Cheo Molecular Genetics Diagnostics Laboratory - Gamma-dynacare

Completing the CHEO Molecular Genetics Diagnostics Laboratory requisition form online is an essential step in ensuring accurate genetic testing for patients. This guide will provide you with clear instructions on how to properly fill out each section of the form, allowing you to navigate the process smoothly.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the online requisition form and open it for editing.
2. Begin by entering the patient's name in the designated fields. Make sure to fill in the last name first, followed by the first name.
3. Input the patient’s address, including city, province, and postal code. This will ensure proper identification and communication.
4. Add the patient’s date of birth in the required format (DD/MM/YYYY) and select the patient’s sex by marking either 'F' for female or 'M' for male.
5. Detail the health care provider(s) requesting the test by completing their name, address, contact number, and any applicable provincial health number.
6. Enter the facility patient ID number if applicable. This helps with tracking the patient’s records across different facilities.
7. If applicable, provide a pedigree number to assist with family genetic history.
8. Complete the section for lab use only, which includes the phlebotomist's name, collection date, and authorized signature.
9. If you are requesting an additional report, fill in the provider's name and address in the specified fields.
10. Choose the test requested from the provided list. Make sure to include any details about ethnic background where noted.
11. Specify the sample required, whether it is blood, DNA, or other types, and fill in the details as necessary.
12. Describe the reason for the test by checking the appropriate box that reflects the patient’s symptoms or purpose of testing.
13. Include any additional relevant clinical or family history information that can aid in the assessment.
14. Indicate whether any other family members have been tested previously and provide their names and relationships if applicable.
15. Once all sections are filled out accurately, you can save your changes, download a copy, print your form, or share it as needed.

Complete your document online today for efficient and accurate processing.