Get Ny Non-permitted Laboratory Test Request Approval Form 2016-2025

Filling out the NY Non-Permitted Laboratory Test Request Approval Form online is a crucial step for obtaining necessary approvals for laboratory tests not permitted in New York State. This guide will provide a clear and detailed overview of each section of the form to assist you in completing it accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Enter today's date in the designated space on the form.
3. Provide the patient's name and unique patient identifier, such as a medical record number, in the specified fields.
4. Document the symptoms, diagnosis, or gene name applicable to the patient in the relevant section.
5. Specify the test requested by filling in the designated field with the accurate test name.
6. Indicate the specimen type, such as blood, plasma, or urine, as required in the provided section.
7. Complete the information for the facility making the request, including the name, address, and contact person details.
8. Fill in the ordering physician’s name, ensuring all pertinent data is accurate to avoid processing delays.
9. Next, provide the information for the laboratory performing the testing, including the laboratory director’s name, institution, address, and contact details.
10. Finally, review the form for completeness, save your changes, and prepare to submit it as indicated in the instructions.

Complete your documents online today to ensure timely compliance and processing.