Get Invitae Confirmation Code Order Id Requisition Form ...

Filling out the INVITAE confirmation code order ID requisition form online can be straightforward when guided step-by-step. This guide will provide clear instructions for each section to ensure accuracy and completeness.

Follow the steps to successfully complete the requisition form.

1. Click 'Get Form' button to obtain the form and access it in your online editor.
2. Begin by entering the patient's information. Fill in their first name, middle initial (MI), last name, date of birth in MM/DD/YYYY format, and specify the ancestry if applicable. Select the patient's sex by marking either ◯M or ◯F.
3. Next, provide the practice information. Include practice name and address, medical record number (MRN), email address for report access, and phone number. Indicate if the patient is deceased by choosing ‘Yes’ or ‘No’ and, if applicable, include the date of death.
4. In the specimen information section, clearly label each specimen tube with the patient's full name, date of birth, and the specimen collection date. Ensure that the correct specimen type is selected, such as ◯Blood, ◯Saliva, ◯Assisted saliva, or ◯DNA.
5. Enter the primary clinical contact details including their name, role/title, phone number, NPI, and email address for report access. If the ordering physician is the same as the primary clinical contact, indicate this by checking the provided box.
6. Specify the reason for testing by including the ICD-10 codes. Provide any additional clinical or laboratory contact information if necessary.
7. If applicable, attach a Letter of Medical Necessity (LMN) along with Medicare billing documents. Complete the Medicare ID number section and select whether Medicare is the primary or secondary payer.
8. For insurance billing, include the billing contact name, policy holder information, and attach relevant insurance documentation. Specify the relationship of the patient to the policy holder.
9. Provide any additional comments or special cases, and ensure the medical professional's signature and date are included at the end of the form.
10. Finally, after completing all sections, save changes, and download or print the form for submission. You may also choose to share it as needed.

Start completing the INVITAE CONFIRMATION CODE ORDER ID Requisition Form online today!