Get Andrology Laboratory Requisition - Fwivf

Filling out the Andrology Laboratory Requisition form can be a straightforward process when you follow the necessary steps. This guide aims to provide clear, detailed instructions tailored to help you complete the form accurately and efficiently online.

Follow the steps to fill out the requisition form correctly.

1. Click ‘Get Form’ button to access the Andrology Laboratory Requisition form and open it in your preferred online editor.
2. Begin by entering the patient's name in the designated field. Ensure that the information is accurate and spelled correctly.
3. Next, input the partner's name in the appropriate field, maintaining accuracy as this information may be necessary for the procedure.
4. Provide the patient’s Social Security Number (SSN) in the specified area, following the format provided in the form.
5. Enter the partner’s date of birth (DOB) in the required field, ensuring the format is consistent with any guidance provided.
6. Input the patient’s date of birth in the corresponding section, again noting the need for accuracy.
7. Fill out the referring physician's information, including the physician's name, clinic name, phone number, fax number, and clinic address in the designated sections.
8. Obtain the physician's signature in the appropriate area to validate the referral.
9. Select the procedure requested by checking the box next to the desired option, such as 'Complete Semen Analysis' or 'IUI Prep'.
10. In the specimen information section, record the collection date and time, followed by the number of days of abstinence.
11. Indicate the place of specimen collection by circling your choice: 'FWF', 'Home', or 'Other'.
12. Circle 'Yes' or 'No' regarding spillage during collection.
13. Select the specimen collection method appropriate for your case by circling one option: 'Masturbation' or 'Condom/Intercourse'.
14. If applicable, document any medications that may affect the procedure in the provided blank.
15. Indicate if there were any transport problems by circling 'Yes' or 'No'.
16. Sign to verify that the semen specimen is a product of the patient or male partner indicated above.
17. Finally, review all entries for accuracy before saving changes, downloading, printing, or sharing the completed requisition form.

Start filling out your Andrology Laboratory Requisition form online today!