Get Carrier Screening Requisition

Filling out the CARRIER SCREENING REQUISITION form online is an essential step in obtaining genetic carrier screening. This guide provides clear instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Provide the patient information. Fill in the last name, first name, date of birth, biological gender, and the name and contact details of the genetic counselor or clinic.
3. Indicate if the patient is a donor by selecting 'Yes' or 'No', then provide the partner or spouse's information, including last name, first name, and date of birth.
4. Complete the provider's signature of consent section, ensuring to certify that the patient and/or their guardian have been informed about the benefits and risks of the tests. The signature is required here.
5. Move to the billing information section, where you will need to fill in the policyholder's details and insurance information.
6. Complete the indications for testing by providing relevant ICD10 diagnosis codes if necessary. Include information about the patient's ethnic background and previous carrier screening if applicable.
7. In the laboratory testing information section, select the relevant tests and provide any previous test order dates.
8. Finalize the form by reviewing all entered information. Save changes, and choose whether to download, print, or share the form as required.

Complete the CARRIER SCREENING REQUISITION online to ensure accurate screening and health insights.