Get Va Dgs-34-101 2008-2025

The VA DGS-34-101 is a Clinical Microbiology/Virology Request Form used by healthcare providers to request laboratory tests. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form electronically and open it in the editor.
2. Begin with the patient information section. Enter the patient's date of birth in the specified format (mm/dd/yyyy) and indicate their age. Fill in the last name, first name, and middle initial. Input the patient's address, including city, state, and zip code.
3. Provide additional details such as the city or county of residence, medical record/chart/accession number, and patient ID. Select the marital status option that applies to the patient and indicate their race and ethnicity by checking the appropriate boxes.
4. In the submitter information section, enter the submitter code number and site code. Then, specify the FIPS code and include the name, phone number, and address of the submitter.
5. List the attending clinician’s name and phone number. Select the site type from the provided options and identify if the patient has any specific relationships or roles relevant to the test request.
6. Complete the patient medical history section. Specify the disease suspected or diagnosed and check the signs or symptoms that apply. Record the date of onset and, if applicable, the date of death.
7. Detail any recent exposure to potential pathogens, list any vaccines that were administered, and provide the date. Also, mention any antibiotics or antiviral treatments that the patient is receiving.
8. Indicate if the test is outbreak-related and, if so, provide the outbreak number. Describe the patient’s role related to the outbreak.
9. Fill out the test request section, providing the patient’s name or identifier, date of birth, and the date the specimen was collected. Select the necessary tests from the list provided.
10. After completing all sections, review the form for accuracy. Users may save the changes, download the form, print it for submission, or share it as needed.

Complete your VA DGS-34-101 form online today for efficient processing.