Get Fi Blueprint Genetics Test Requisition Form 2019-2025

Filling out the FI Blueprint Genetics Test Requisition Form online can seem daunting at first, but with guidance, it becomes a straightforward process. This guide will provide you with step-by-step assistance to ensure that each section is completed accurately and efficiently.

Follow the steps to complete the form with ease.

1. Click the 'Get Form' button to obtain the form and open it in the appropriate interface.
2. Begin with filling in the required fields marked with an asterisk (*). Start by entering the test code and test name. This will specify the genetic test you are requesting.
3. In the sample type section, indicate whether the sample is 'Blood,' 'Saliva,' or 'DNA' and provide the sample collection date.
4. For additional test information, enter the previous order ID if applicable, and provide details regarding any ongoing pregnancies or previously tested family members.
5. Complete the ordering health care professional information section. Input your name, full address, institution, email, NPI number (for US only), and phone number.
6. Choose the method for delivering results: either mail or fax, and fill in the necessary details including contact information for results sharing.
7. In the patient information section, provide the patient’s first name, last name, date of birth, and contact details including address, phone, and email.
8. Complete the patient history section by selecting the sex, indication for testing, whether the patient has died, and providing ICD-10 codes for insurance if applicable.
9. In the variant specific testing information, select either familial variant testing or targeted variant testing, and complete all relevant fields including the index patient’s information.
10. Fill out the billing information section by entering insurance details or choosing institutional billing, as well as the patient payment information.
11. Ensure that the ordering health care professional signature section is completed. The professional must confirm informed consent and the medical necessity of the test.
12. Finally, review all the filled information for accuracy, then save changes, download, print, or share the completed form as needed.

Proceed to complete the FI Blueprint Genetics Test Requisition Form online today.