Get Tempus Requisition Form 2020-2025

Filling out the Tempus Requisition Form online can streamline the process of ordering genetic testing for patients. This guide provides clear instructions on how to complete each section of the form, ensuring you provide all necessary information accurately and efficiently.

Follow the steps to successfully complete the Tempus Requisition Form.

1. Click ‘Get Form’ button to obtain the Tempus Requisition Form and open it in the editor.
2. In the 'Ordering Physician Information' section, enter your full name, email address, and phone number. Ensure that the email address provided is where the test results will be sent.
3. Fill in the 'Patient Information' details, including the last name, first name, date of birth, medical record number, and primary phone number. Additionally, complete the address fields, making sure to include the city, state, postal code, and country.
4. Select appropriate options under 'Panel Test Options'. Choose either Tempus xT or xF based on the patient's needs and specify any additional options for FFPE tissue.
5. In the 'Specimen Retrieval' section, indicate the specimen to be tested, providing all necessary details, including pathology lab information, collection dates, and case numbers as required.
6. Document the 'Current Diagnosis' along with any relevant ICD-10 codes and cancer-related statuses. Specify the stage of the disease and any additional details as necessary.
7. Complete the 'Billing Information' section. Enter the primary insurance details, policy holder information, and relationship to the policy holder.
8. Sign the form in the 'Physician Signature' area to certify that you have explained the testing process to the patient.
9. If additional physicians need to be copied, fill out the 'Additional Physician to Be Copied' section with their contact details.
10. Review all sections to ensure accuracy. Once you have filled out the form, you can save changes, download, print, or share the completed document as needed.

Complete your Tempus Requisition Form online today to streamline patient testing!