Get Vt Micro 220 2020-2025

The VT Micro 220 is a critical document for submitting clinical test requests to the Vermont Department of Health Laboratory. This guide will provide you with clear instructions on how to effectively and accurately fill out this form online, ensuring a smooth submission process.

Follow the steps to fill out the VT Micro 220 online, ensuring all sections are completed accurately.

1. Press the ‘Get Form’ button to access the VT Micro 220 document and open it in the online editor.
2. Begin with the specimen information section. Enter the date of collection and date of onset in the respective fields.
3. Fill in the clinical laboratory or practice information. Provide the name, address, city or town, state, telephone number, zip code, and fax number, ensuring that all details are accurate.
4. In the patient information section, enter the patient's first name, city or town, state, MRN or ID number, specimen ID number, referring physician’s names, date of birth, NPI number, and gender. Select the appropriate checkbox for gender and provide additional comments if necessary.
5. Indicate the patient's race and ethnicity by selecting the appropriate options from the provided list. If the individual has no insurance, check the respective box.
6. Complete the billing information section by attaching a copy of their insurance card, including insurance company name, ID number, group number, subscriber name, and relationship.
7. Specify the specimen source and type, such as blood, urine, or swab, by selecting the appropriate options or writing in specific locations.
8. Provide details for the reason for the test, such as diagnostic purposes or exposure confirmation, by marking the relevant points.
9. Complete any necessary additional questions, including travel history or employment in healthcare.
10. Once all sections are accurately filled, save your changes. You can then download, print, or share the completed form as needed.

Complete your VT Micro 220 form online today to ensure timely testing and results.