Get Dch 0567 - State Of Michigan - Michigan

Filling out the DCH 0567 form accurately is crucial for efficient processing of laboratory test requisitions for Chlamydia trachomatis. This guide provides step-by-step instructions to assist you in completing the form online, ensuring that all necessary information is provided correctly.

Follow the steps to complete the DCH 0567 form online.

1. Click the ‘Get Form’ button to access the DCH 0567 form and open it in your browser.
2. Begin by filling in the submitter information. Enter the agency code if known, and specify where the results should be sent (phone, fax) along with the contact person's name and identifier number.
3. Record the date and time of specimen collection. Ensure you select the correct month, day, and year.
4. Fill in the patient's name, including the last name, first name, and middle initial or a unique identifier, making sure it matches the specimen label exactly.
5. Provide the patient’s city of residence and the corresponding zip code.
6. Select the test requested and indicate the specimen source by choosing only one option, such as 'C. trachomatis only (non-culture)'.
7. Check the appropriate gender, race, and ethnicity of the patient. Include options for all applicable categories.
8. If necessary, enter the submitter’s patient number, date of birth, and Medicaid number or plan first number.
9. Indicate any symptoms or diagnosis related to the patient's condition, selecting from options provided or specifying any other relevant information.
10. Complete the reason for testing by checking all applicable circumstances, ensuring to reference definitions provided on the form.
11. Before finalizing, review all the information entered for accuracy and completeness.
12. Once satisfied with the entries, save changes, and choose to download, print, or share the completed form as required.

Begin filling out your DCH 0567 form online today to ensure prompt processing and accurate results.