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Get Account Setup Form - Vectra Da
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How to fill out the Account Setup Form - Vectra DA online
Filling out the Account Setup Form for Vectra DA is an essential step in establishing your clinic's account. This guide will walk you through each section of the form, ensuring a smooth and efficient process for users of all experience levels.
Follow the steps to complete the Account Setup Form seamlessly.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the clinic and ordering physician information. Fill in the clinic or institution name, address, city, state, phone number, and ZIP code. Indicate your preferred method of delivery for reports by selecting either Vectra View, fax, or mail.
- Provide details for the primary ordering provider. Complete fields for their first name, last name, national provider identifier (NPI) number, middle initial (MI), specialty, and email. If the ordering physician’s fax is different from the clinic's fax, include that number as well.
- Optional sections allow for the inclusion of up to three additional ordering providers. Repeat the process of entering the details for first name, last name, NPI number, MI, specialty, email, and fax number if different.
- Next, fill in the account information section. Provide the title, name (if different from the primary physician), phone number, and email of the primary contact.
- Finally, ensure you attach a completed supplies order form if you wish to request test requisition forms and specimen collection kits. Also, note the laboratory I.D. number and CLIA number provided.
- Once you have filled out all sections accurately, you may save changes, download, print, or share the completed form as needed.
Start filling out your documents online today for a streamlined experience.
An order for Vectra® DA includes and requires an order for 12 biomarkers: VCAM-1, EGF, VEGF-A, IL-6, TNF-RI, MMP-1, YKL-40, Leptin, Resistin, SAA, CRP. These 12 biomarkers are required to generate the Vectra® DA test score.
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