Get Requisition Form - Upmc Molecular Genomic Pathology Lab

This guide provides step-by-step instructions for filling out the Requisition Form for the UPMC Molecular Genomic Pathology Lab online. It aims to assist users in providing the necessary information accurately and efficiently.

Follow the steps to complete the online requisition form accurately.

1. Press the ‘Get Form’ button to access the requisition form and open it in your editor.
2. Begin filling out the 'Patient Identification' section. Provide the patient's last name, first name, middle initial, birthdate, and sex. Ensure that the information is accurate and clearly entered.
3. In the 'Client Information' section, enter the patient's diagnosis, social security number or medical record number, and the relevant ICD-10 code(s). If applicable, include the surgical path or cytology number.
4. Complete the 'Requesting Institution / Physician' section. This includes inputting the requesting physician's name, address, phone number, and fax number.
5. Move on to the 'Billing Information' section. Fill in the details of the person or institution responsible for payment, including their address and phone number.
6. In the 'Specimen Information' section, list the collection date and time, and specify the source of specimen from the options provided. Ensure to select all applicable options.
7. Select the tests you are requesting within the 'Tests' section. Tick all relevant boxes for the tests being ordered. Attach any necessary supporting documents, such as surgical pathology or cytology reports.
8. If there are additional specimen notes or comments, utilize the provided space to include this information.
9. After completing all sections, review the entire form for accuracy. Make any necessary corrections before finalizing.
10. Once you are satisfied with the information provided, save your changes. You can then download, print, or share the completed form as needed.

Take the next step in efficient document management by completing your online requisition form today.