Get 01 Thal - Request & Consent Form - Edit Versi2.0 Edit 2015-11-05 With Bm Consent.docx - Hkl Gov

Filling out the 01 Thal - Request & Consent Form is a crucial step for assisting individuals in requesting genetic testing for thalassemia syndromes. This guide provides clear and concise instructions on how to successfully complete the form to ensure proper submission and processing.

Follow the steps to effectively complete the form online.

1. Click the ‘Get Form’ button to obtain the form and initiate the process of filling it out.
2. Begin by entering the patient information in the designated fields. This includes the patient's name, date of birth, patient ID or identification number, and age. Ensure accuracy in this section, as this information is vital for identification.
3. Proceed to specify the patient's ethnicity and gender, marking the correct boxes. If applicable, indicate whether the female patient is pregnant, along with the number of weeks if yes.
4. Provide the address where the report should be sent, along with the hospital or clinic details. Include the relevant hospital lab number and the type of specimen being submitted for testing.
5. In the family history section, include any pertinent clinical diagnosis and family pedigree information. Ensure to answer questions related to whether anyone in the family has undergone DNA testing and provide results if applicable.
6. Indicate the type of test requested by marking the appropriate boxes. If the patient is not the index case, provide the name and ID number of the index case along with the relationship to that case.
7. Complete the important checklist by attaching all necessary documents requested, such as recent FBC results and Hb analysis results. Ensure all required documentation is included to avoid delays.
8. Finally, the authorized requesting doctor must sign, date, and stamp the form, affirming the request for genetic testing. Review all fields for correctness before final submission.

Complete the 01 Thal - Request & Consent Form online to facilitate timely genetic testing for thalassemia syndromes.