Get Gems Pathology Clinical Request Form

Filling out the GEMS Pathology Clinical Request Form online is an essential step for users seeking pathology services. This guide provides step-by-step instructions to help users navigate the form efficiently and accurately, ensuring all necessary details are included for a smooth process.

Follow the steps to complete the GEMS Pathology Clinical Request Form online.

1. Press the ‘Get Form’ button to access the GEMS Pathology Clinical Request Form and open it in your preferred editing tool.
2. Complete the 'Copies to Doctors' section by entering the names or details of any doctors who should receive a copy of the results.
3. Fill out the 'Contact Person' section with the name and contact information of an individual who may be reached about this request.
4. Indicate the 'Test Laboratory' where the tests will be conducted.
5. Select the urgency of the request by marking either 'Urgent' or 'Routine'.
6. Provide the 'Referring General Practitioner Details,' including the doctor's name, practice number, telephone number, and fax number.
7. Enter the email address of the referring general practitioner.
8. The 'Patient Details' section requires the patient to indicate their gender, surname, and date of birth.
9. In the 'Person Responsible for Payment of Account' section, enter the responsible party’s ID number, surname, first name, medical scheme name, and telephone number.
10. Fill in the medical scheme option and postal address.
11. Specify the dependent code and membership number if applicable.
12. Patients are required to certify that the provided information is correct and give consent for the selected tests by signing the form.
13. Complete the 'ICD 10 Codes' section as necessary.
14. Submit any additional clinical data, specimen type, and collection details.
15. Once all sections are completed, save the changes, download, print, or share the form as required.

Complete your GEMS Pathology Clinical Request Form online to ensure timely processing of your pathology tests.