Get Cellnetix Consult Request Form

Filling out the CellNetix Consult Request Form online is a straightforward process that ensures your requests for consultations are properly documented. This guide will walk you through each section of the form, providing clear instructions to help you complete it accurately.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the 'Patient Name' field. Enter the full name of the patient as it appears on their medical records.
3. Next, locate the 'DOB' field, where you should input the patient's date of birth in the format requested.
4. In the following section, provide the name of the laboratory where the slides are located. This ensures proper tracking of the specimens.
5. Fill out the 'Phone of Above Lab' field with the contact number for the laboratory. Double-check the number for accuracy.
6. Complete the 'Date of Original Service' field by entering the date when the original service was provided to the patient.
7. Input the 'Accession Number/Case Number'. This number is crucial for tracking and managing the case efficiently.
8. Identify the 'Requesting Physician' by entering their name, ensuring it corresponds to the physician associated with this request.
9. The form requires the 'Requesting Physician Signature.' If filling out the form online, ensure you have a method to provide an electronic signature or print to sign later.
10. Finally, indicate the date on which the form is being completed. This provides a record of when the request was initiated.
11. Once you have filled out all required fields, review your entries for any inaccuracies. After confirming the information is correct, you can save changes, download, print, or share the form as needed.

Complete your documents online today to ensure efficient processing of your consult requests.