Get Gphl Submission Form_- Georgia Department Of Public ...

This guide provides clear and detailed instructions on how to fill out the GPHL Submission Form required by the Georgia Department of Public Health. By following these steps, users will streamline the submission process and ensure all necessary information is accurately provided.

Follow the steps to successfully complete the submission form.

1. Press the ‘Get Form’ button to access the GPHL Submission Form, which you can then open in your preferred online editor.
2. Begin by completing the health care provider information section. Indicate the lab where the test will be performed (Decatur or Waycross) and provide the submitter code and name, county of residence, and contact information.
3. Fill out the patient information by entering the patient's ID number, name, date of birth, address, and phone numbers. If applicable, include details about the parent or guardian.
4. In the insurance information section, provide the necessary details including the accepted insurance company, ID number, plan name, policy holder's information, and a copy of the patient's insurance eligibility document.
5. Complete the specimen information portion by specifying the type of specimen and its source. Enter the date and time of collection and whether it is related to an outbreak or travel.
6. Indicate the requested tests by checking the appropriate boxes or filling in the required fields, especially for specialized testing, and ensure all relevant codes are recorded.
7. Review all entered information for accuracy. Make any necessary edits before submitting the form.
8. Once completed, you can save the changes, download the form, print it, or share it as necessary.

Complete your GPHL Submission Form online today to ensure a smooth processing experience.