Follow the steps to complete your online requisition form

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the facility name where the specimen was collected, along with the collection date and time.
3. Provide information for the requesting entity, including the name, address, and contact details of the ordering physician.
4. Specify the specimen source and include the specimen ID if available. Indicate if multiple specimens are submitted and specify the request method, such as 'Test Separately' or 'Combine'.
5. Under the billing information section, complete the details accurately, specifying whether to bill insurance, the patient, or the requesting entity.
6. For patient information, include the patient's full name, date of birth, medical record number, and other relevant details like the address and phone.
7. Document the clinician’s referral or authorization number as necessary and provide the corresponding ICD-10 codes to support medical necessity.
8. Fill in the treating physician's information clearly to ensure the successful mailing or faxing of the pathology report.
9. Select the clinical history and consultation services required, indicating the level of service and any specific tests needed.
10. Review the completed form for accuracy and completeness. Once all sections are filled out, you can save changes, download, print, or share the form as needed.

Complete your WA PhenoPath Requisition 0005 online today for timely and accurate processing.