Follow the steps to complete the requisition form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the physician's information in the designated fields. This includes the ordering physician's name, address, city, state, zip code, phone, and fax numbers.
3. Next, fill in the patient information section. Provide the patient's last name, first name, middle initial, address, city, state, zip code, medical record number, date of birth, sex, and whether the patient has recently been pregnant.
4. Continue to the clinical information section. Enter the collection date, the type of specimen collected (blood or cord blood), collection time, and the name of the person who collected the sample. Indicate if the patient has recently been transfused.
5. In the referring diagnoses section, check all applicable boxes to indicate the patient's diagnoses. Include any relevant ICD-10 codes.
6. Select the desired testing options from the requested testing section, ensuring you provide all necessary details, such as the required specimen tubes and volumes.
7. If applicable, specify any microdeletion FISH analysis requested by checking the appropriate boxes.
8. Complete the patient financial authorization and insurance benefit verification section. Ensure you sign and date where required and include any necessary insurance information.
9. Review the specimen collection and handling requirements to ensure you comply with all guidelines. This includes using the correct containers and labeling specimens properly.
10. After filling out the form, save your changes. You may download, print, or share the completed form as needed.

Complete your documents online efficiently and ensure all sections are thoroughly filled.