Get Miraca Life Sciences Slide Release Form

Completing the Miraca Life Sciences Slide Release Form online is a straightforward process that ensures your request is submitted accurately. This guide will provide you with step-by-step instructions to fill out the form effectively.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to access the form and open it in the document editor.
2. Begin by entering the request information. Fill in the request date, your phone number, and the name of the person requesting the slides. Ensure this information is accurate, as it will be used for communication regarding the request.
3. Indicate whether this is a legal consultation by checking the appropriate box for 'Yes' or 'No'.
4. In the billing section, specify who the bill will be directed to by checking the corresponding box for 'Patient' or 'Requesting Physician'.
5. Detail any special requests, particularly if unstained slides are needed, by noting the quantity in the provided space.
6. Require a signature from the physician or the patient if the slides/blocks are being released to the patient.
7. Complete the patient information section by entering the patient’s name, date of birth, and the Miraca Life Sciences accession number.
8. For shipping preferences, choose how you would like the case materials to be sent by selecting one of the options: UPS Ground, Two-Day delivery, or Overnight.
9. Fill in the shipping address details, including address line 1, address line 2, address line 3 (if applicable), city, state, zip code, and contact phone and/or fax number.
10. Specify who should receive a copy of the diagnostic report, ensuring you provide the appropriate details.
11. In the section for Caris Life Sciences use only, identify whether recuts or originals are being sent and provide the number of slides or blocks sent. Ensure that the slide or block reviewer’s name is filled in as well.
12. Once all fields are completed, save your changes. Depending on your needs, download the completed form, print it, or share it as required prior to faxing the requisition back to 866.688.3280.

Complete the Miraca Life Sciences Slide Release Form online today to ensure timely processing of your request.