Get Cystic Fibrosis Testing Patient Information Sheet - Metropolitan ...

Filling out the Cystic Fibrosis Testing Patient Information Sheet is an essential step in ensuring accurate testing and reporting. This guide provides clear instructions for each section of the form to help users complete it efficiently and accurately.

Follow the steps to fill out the form

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editing platform.
2. Begin by entering the patient's name in the 'Name of Patient' section, ensuring to include the last name, first name, and middle initial if available.
3. Select the appropriate gender by checking the 'Male' or 'Female' box.
4. Indicate whether the patient or their partner is currently pregnant by selecting 'Yes' or 'No' and filling in 'how many weeks gestation' if applicable.
5. Provide the patient's date of birth in the specified format (mm/dd/yyyy).
6. In the 'Who should receive reports' section, fill in the requesting physician's name, phone number, and fax number.
7. Enter the MML accession number if available.
8. Select the ethnic background of the patient by checking all applicable boxes and specifying country of origin.
9. In the 'Reason for Testing / Family History' section, check all relevant reasons for testing and indicate if there is a family history of cystic fibrosis.
10. If there is a family history, detail the relationship to the patient and whether the relative is a carrier or affected with cystic fibrosis.
11. Query if the patient's reproductive partner is a carrier of cystic fibrosis and if they have a family history of it as well.
12. List all relevant clinical symptoms experienced by the patient by checking the appropriate boxes and writing any additional symptoms.
13. If applicable, indicate whether sweat chloride testing has been performed and document the results.
14. Once all sections are completed, save your changes, download the completed form, or print it out for submission.

Complete your Cystic Fibrosis Testing Patient Information Sheet online today.