Get Neurology Test Request Form - Mayo Clinic

Filling out the Neurology Test Request Form from the Mayo Clinic online can simplify the process of submitting your test requests. This guide provides clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the form smoothly.

1. Click ‘Get Form’ button to obtain the Neurology Test Request Form and open it in the editor.
2. Begin with the client information section. Provide necessary details such as the client’s name, phone number, and account number. Ensure this information is accurate as it is essential for processing.
3. Next, fill out the patient information section. Enter the patient's name, birth date, and address. Include the patient's ID or medical record number, as well as their contact details.
4. In the 'Submitting Provider/Provider Name Information' section, input the details of the referring provider. Include their last name, first name, and any necessary identification such as the provider's National I.D. (NPI).
5. Provide the insurance information only if a callback is required. Include the subscriber’s name, relationship to the patient, insurance company name, and relevant policy or group numbers.
6. Indicate the reason for the referral and ensure that the appropriate ICD-10 diagnosis code is included for accurate billing and documentation.
7. Ensure that all required fields are filled in and review your entries for any mistakes or omissions.
8. Once the form is complete, save the changes to your document. You then have the option to download, print, or share the completed form as needed.

Complete your documents online today to facilitate quicker processing of your requests.