Get Cytogenetic Requisition Patient Information Other Than

Filling out the CYTOGENETIC REQUISITION Patient Information OTHER THAN form can seem daunting, but with careful attention to detail, you can accurately provide the necessary information. This guide will walk you through each section of the form to ensure that you submit complete and correct data.

Follow the steps to effectively complete the CYTOGENETIC REQUISITION Patient Information form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin by filling in the patient’s name. Ensure that you print the surname and first name clearly.
3. Provide the complete address where the patient resides, including the city and postal code.
4. Fill in the date of birth (DOB) in the specified format (DD/MM/YY). Choose the appropriate sex designation by marking 'M' or 'F.'
5. Enter the health card number, as this information is mandatory for processing the specimen.
6. Indicate the ordering physician’s name by printing their surname and first name.
7. If additional copies of the report are needed, provide the names and addresses of each recipient here.
8. Record the date the sample was taken, ensuring it is in the correct format (DD/MM/YY).
9. Fill in the ward or hospital where the sample was collected, along with the physician's signature.
10. Proceed to the specimen submission section, detailing how the sample should be transported and any specific handling instructions.
11. Indicate whether the sample is routine or urgent by marking the appropriate box.
12. If applicable, indicate if there is a pregnancy at risk, and provide the gestational age in weeks.
13. Select the testing requested by marking the relevant options and providing any clinical indications required.
14. If FISH or QF-PCR testing is requested, fill in the respective sections with the needed details.
15. Ensure all mandatory fields are completed, as the specimen cannot be processed without this information.
16. Once the form is accurately filled out, save your changes, and download or print the document as necessary for submission.

Submit your completed CYTOGENETIC REQUISITION Patient Information form to ensure timely processing.