Get Fi Blueprint Genetics Test Requisition Form

This guide provides a clear and supportive overview of how to complete the FI Blueprint Genetics Test Requisition Form online. By following the steps outlined below, users can efficiently fill out each section of the form to ensure accurate and timely processing of their genetic testing requests.

Follow the steps to complete the requisition form accurately.

1. Click the ‘Get Form’ button to access and open the FI Blueprint Genetics Test Requisition Form.
2. Begin by filling out the required fields, denoted with an asterisk (*), including the test code and test name. Make sure to select the analysis type and sample type from the options provided.
3. Input the sample collection date and check eligibility for the family extension service by visiting the relevant webpage.
4. Complete the additional test information section if applicable, including specifying the previous order ID and providing details related to ongoing pregnancies if relevant.
5. Fill out the ordering health care professional information, including full name, institution, email, NPI number, and phone number.
6. Choose how to receive results by selecting options for delivery (mail, fax, or online system).
7. Complete the patient information section, ensuring to include the first and last name, date of birth, contact information, and any required identifiers.
8. Provide patient history information, including sex, indication for testing, ICD-10 codes, and pertinent clinical findings.
9. If applicable, fill out the family member test information, indicating the reason for testing and relevant gene mutations.
10. Complete the billing information section, including insurance details and billing options. Make sure to include necessary documentation.
11. Have the ordering health care professional sign and date the form, certifying that informed consent has been discussed.
12. Review all information for accuracy and completeness. Once finished, save your changes and proceed to download, print, or share the completed form as necessary.

Begin filling out the FI Blueprint Genetics Test Requisition Form online now to ensure prompt processing of your request.