Get Therapeutic Drug Monitoring (tdm) Test Request Form Clinical Centre Information Lab21 Id Requesting

Filling out the Therapeutic Drug Monitoring Test Request Form is essential for submitting accurate and comprehensive information for lab analysis. This guide provides step-by-step instructions for successfully completing the form online, ensuring clarity and precision.

Follow the steps to accurately complete the TDM test request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the requesting doctor's name and the hospital or clinic details in the designated fields. Ensure you provide accurate contact information including the address, telephone number, fax, postcode, and email.
3. Next, affix the clinic label below the patient information section. Fill in the hospital or clinic number, patient ID, weight, height, and date of birth. Make sure all patient data is complete.
4. Enter the sample ID and viral load accurately. It is important to complete a new test request form for each sample submitted; do not combine multiple time points such as peak and trough samples on one request form.
5. In the sample to be tested section, specify the sample type (Plasma Only) and the date it was taken. Indicate the constituent drugs you wish to analyze. If the patient is on combination therapy, list the individual drugs.
6. Complete the dosing information by filling out the dose in mg, the time taken, and ticking the appropriate dosing frequency and time elapsed since the last dose.
7. Indicate any other antiretroviral therapy under the corresponding section. This is crucial for the lab to understand the patient's full treatment regimen.
8. Select the appropriate reason for TDM by ticking all that apply. Options include pregnancy, dialysis, paediatric, renal failure, possible drug interaction, suspected treatment failure, liver failure, inpatient/ITU, suspected toxicity, and other.
9. Add any additional comments relevant to the request. This could provide the lab with valuable context regarding the samples or treatment.
10. Finally, confirm that all information is accurate and complete. You can then save changes, download, print, or share the form as required.

Complete your TDM test request form online today for prompt and accurate lab analysis.