Get Summit Pathology

Filling out the Summit Pathology form online is a straightforward process designed to facilitate the submission of important pathology requests. This guide provides step-by-step instructions to ensure that all necessary information is accurately completed.

Follow the steps to successfully complete the Summit Pathology form.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by filling out the patient information section. Enter the patient's full name in the provided fields, including last name, first name, and middle initial. Provide the patient's address, city, state, and zip code. Also, include their date of birth and a contact phone number.
3. In the submitting physician section, record the name of the physician submitting the request. Ensure that the information is printed clearly.
4. Indicate the patient's sex by selecting either 'Female' or 'Male.'
5. Provide the patient's Social Security Number (SSN) and ensure a copy of the patient's insurance card (front and back) is attached as required.
6. Select the appropriate insurance type by marking the relevant checkbox, such as Medicare, Medicaid, or Self-Pay. If applicable, include any Workman’s Comp claim number and details about the employer.
7. Fill out the specimen information and collection details. Record the collection date and time (AM/PM) accurately. Describe the specific specimen type and diagnosis using the provided diagnosis/ICD9 field.
8. In the specimen section, complete all relevant fields labeled A through J as needed, providing any history pertinent to the specimen.
9. Ensure that the physician's signature is included, along with the date to validate the request.
10. After completing all sections, review the filled form for accuracy. You can then save changes, download, print, or share the form.

Complete your Summit Pathology form online today for efficient processing.