Follow the steps to complete the Tempus Requisition Form online

1. Click the ‘Get Form’ button to access the Tempus Requisition Form and open it in your online editor.
2. Fill out the patient information section, including the patient's last name, first name, medical record number, date of birth, sex, race/ethnicity, and contact details.
3. Complete the ordering physician information section by providing the physician's name, contact information, and their office or practice details.
4. Select the appropriate panel test options based on the patient's condition and the test requirements. Indicate if additional tissue is needed for testing or if a liquid biopsy is an option.
5. Provide the current diagnosis, including the relevant ICD-10 codes and any details about the disease status.
6. Complete the billing information by including the primary insurance details and the patient's relationship to the policyholder.
7. Ensure the physician signature is provided to certify medical necessity and informed consent.
8. If applicable, complete the pathology release section and indicate if the pathology lab is part of the treatment team.
9. Fill out any additional clinical information required, including surgical procedures and current cancer medications.
10. Review all entered information for accuracy, then save changes, download, print, or share the form as needed.

Complete your Tempus Requisition Form online today to facilitate timely patient care.