Get Fullerton Genetics Center 9 Vanderbilt Park Dr Asheville ...

This guide provides clear and supportive instructions for completing the Fullerton Genetics Center Laboratory Requisition Form online. By following these steps, users can ensure that all necessary information is accurately submitted for genetic testing.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to access the Fullerton Genetics Center Laboratory Requisition Form and open it for editing.
2. Begin by filling out the patient information section. Include the patient's last name, first name, middle initial, medical record number, sex, date of birth, address, and social security number. Ensure that highlighted fields are correctly filled as they are required.
3. Provide the contact details for the referring physician, including their name, address, institution, phone number, and NPI number.
4. Complete the genetic counselor or care coordinator section by entering their name and contact information.
5. Fill in the billing information by selecting the appropriate billing option (either billing the patient or the physician's office) and providing the insured person's details if applicable.
6. Specify the sample information such as specimen type (e.g., blood, buccal swab) and the collection date. Also, provide clinical indications for the study, including any relevant ICD10 codes.
7. Address any family history or known mutations if applicable, and specify if the patient is currently pregnant, including gestational age and fetal sex if known.
8. Indicate informed consent by checking 'Yes' or 'No'. Provide any additional comments or clinical information related to the patient.
9. After completing all sections, review the form for accuracy. Save your changes, and then choose to download, print, or share the completed form as needed.

Complete the Fullerton Genetics Center Laboratory Requisition Form online today.