Get To Get Patient Isolate Requisition Form - The University Of Texas ... - Uthct

Filling out the To Get Patient Isolate Requisition Form is a crucial step in submitting patient specimens for analysis. This guide provides detailed instructions on each section of the form to ensure that you complete it accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Patient Identification' section, you must provide the patient's name, date of birth (DOB), and specimen number. Ensure that the samples submitted are pure culture isolates, packaged properly to avoid leakage.
3. Indicate the patient's sex, underlying disease, prior antibiotic treatment, and source of the specimen. It is important to specify the suspected organism while noting that isolates of M. tuberculosis should not be sent.
4. For the collection information, fill in the date the specimen was collected from the patient and provide the details of where the report should be sent, including the name, phone number, and address.
5. Complete the billing address section. Note that this form does not bill insurance companies, Medicare, or patients directly.
6. Provide the attending physician's name, address, and phone number. Include who should be contacted for critical results.
7. Fill in details for the person submitting the specimen, including their name, phone number, and type of medium submitted.
8. Indicate whether you are requesting susceptibility tests or identification from the submitting institution.
9. Before finalizing, ensure you have reviewed all information for accuracy. Once confirmed, you can choose to save your changes, download the form, print it, or share it as needed.

Take action now and complete the To Get Patient Isolate Requisition Form online for efficient processing of your specimen.