Get Ahus Genetic Panel Order Form 48 Hours - Machaon Diagnostics

Filling out the AHUS Genetic Panel Order Form can be straightforward when you follow the right steps. This guide will provide comprehensive instructions to help you successfully complete the form online.

Follow the steps to fill out the AHUS Genetic Panel Order Form.

1. Click ‘Get Form’ button to download the form and open it in your preferred editor.
2. Begin by entering the patient's information in the designated fields. Include the patient's name (Last, First, M.I.), gender, specimen date and time, medical record or ID number, date of birth, and social security number.
3. Next, fill in the ordering physician information. Provide the physician's name, NPI number, facility phone number, and a contact phone number for results.
4. Complete the billing information section. Indicate whether the billing is to the facility or insurance. If it is to insurance, ensure to fill in the patient’s insurance company details, including policy number, group number, and authorization number if applicable.
5. In the test selection section, respond to whether the patient has had a bone marrow transplant and provide specified test results such as PLT count, hemoglobin, and LDH where applicable.
6. Fill in any available clinical information including ADAMTS-13 and inhibitor details.
7. Ensure specimen collection and processing instructions are followed. Document the various collection steps, including drawing blood and labeling the specimen tube properly.
8. In the outpatient only section, provide the patient's insurance information and include diagnosis codes as necessary.
9. Finally, obtain the patient's signature and date on the designated line, ensuring all necessary authorizations are acknowledged for billing and information release.
10. Review all entered information for accuracy, then save changes, download, print, or share the completed form as needed.

Complete the AHUS Genetic Panel Order Form online to ensure a smooth and swift processing experience.