Follow the steps to accurately complete the form online.

1. Press the ‘Get Form’ button to access the Hepatic Pathology Additional Information Request form and open it in your preferred online editor.
2. In the 'To' field, specify the recipient of the request, which would generally be the Joint Pathology Center.
3. In the 'From' field, enter your name or the name of the individual submitting the request.
4. Provide a contact telephone number in the designated field to facilitate communication.
5. If applicable, include a fax number in the 'Fax' field, where a response may be sent.
6. Enter the email address of the sender to receive updates or confirmations electronically.
7. Fill in the JPC Accession Number, a unique identifier for the case you are referencing.
8. In the 'Patient Name' field, input the full name of the patient related to the case.
9. Provide the Surgical Case Number if available, which may be beneficial for record-keeping.
10. In the section asking for additional information, thoroughly address the following prompts to aid in the pathology interpretation: Indication for biopsy or operation, basis for previous diagnosis, operative findings, clinical evidence of liver disease, history of alcohol use, hepatitis exposure, history of diabetes or obesity, medications, and relevant imaging studies.
11. List laboratory data, specifying the dates obtained for each test, including AST, ALT, Alkaline Phosphatase, GGTP, Bilirubin, Total Protein, Albumin, Prothrombin Time, Cholesterol, Glucose, and any relevant serological tests.
12. Once all fields are filled in correctly, review the information for accuracy. Make any necessary edits before finalizing.
13. After completing the form, you can save your changes, download the form, or print it out for submission.
14. Submit the information as soon as possible by faxing it to 301-295-0104 or following any other preferred submission method.

Complete the Hepatic Pathology Additional Information Request form online today to ensure a smooth consultation process.