Get Amerk

Filling out the Amerk is a crucial process for submitting clinical lab requests efficiently and accurately. This guide will provide you with step-by-step instructions to ensure you complete the form correctly and understand its components.

Follow the steps to successfully complete the Amerk form.

1. Click ‘Get Form’ button to access the document and open it for editing.
2. Complete the left section of the form with the patient's information, including their name (last and first), date of birth, and Social Security Number (SSN). Ensure that all fields marked as 'REQUIRED' are filled out.
3. Enter the ordering physician's information, including their name and phone number. This is essential for any follow-up communication regarding the clinical lab request.
4. Specify the specimen type for the tests ordered. Select 'Anti-Merkel Cell Panel' and confirm the quantity of serum required.
5. Indicate the date and time the specimen was collected. This helps to document the sample's viability for testing purposes.
6. Address the question regarding the presence of Merkel Cell Carcinoma (MCC) evidence at the time of blood draw with a 'Yes' or 'No' response. If applicable, provide details on how long it has been since the last evidence of MCC.
7. Fill in the ICD-9 diagnosis code relevant to the patient's condition as instructed. You can refer to the table of ICD9 codes included in the form for assistance.
8. Provide the name and address of the recipient or facility to which the report should be sent, ensuring it is legible and complete.
9. If the patient has other insurance, document this information in the corresponding section of the form.
10. Review all the completed sections for accuracy and completeness before saving your changes. You now have the option to download, print, or share the form as needed.

Complete your lab requisition efficiently by filling out the Amerk online today.