Get G-2b Form Sep 2016 Rev1 Final - Sample.doc - Dshs Texas

Filling out the G-2B Form is an essential step for submitting specimens to the Texas Department of State Health Services. This guide provides clear and comprehensive instructions to help you complete the form online accurately and efficiently.

Follow the steps to complete the G-2B Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editing tool.
2. Begin by filling out Section 1, the submitter information. Complete all fields marked with double asterisks (**), including the submitter name, TPI number, and address. Ensure that contact information is accurate for any follow-up regarding the specimen.
3. Proceed to Section 2, patient information. Include all required information such as the patient's last name, first name, date of birth, and address. Double-check that the patient's name matches the ones listed on the Medicare/Medicaid card and specimen container.
4. In Section 3, specify the specimen source or type. Select from the provided options, ensuring to mark any applicable site or source where the specimen originated.
5. Continue to Section 4, parasitology, and Section 5, bacteriology, to indicate if your specimen requires any specific tests. Each test block may require a separate form.
6. Fill out Section 6 with the ordering physician's information, including their NPI number, which is required for billing purposes.
7. In Section 7, payor source, mark only one box to indicate how the bill should be processed. Ensure all required billing fields are filled completely to avoid being billed directly.
8. Review all entries for accuracy. Ensure that all required identifiers are provided, particularly for the submitter and patient information.
9. At the end of the form, provide your signature and date in the specified areas to authorize the release of information if necessary.
10. Finally, save your changes. You may then download, print, or share the completed form as needed.

Complete your G-2B Form online today to ensure your specimens are processed efficiently.