Get Hu Man Ge Ne Tics La Boratory Www - Unmc

This guide provides a clear pathway for users to accurately complete the hu man ge netics laboratory form. It outlines each section and field, ensuring that users feel supported throughout the process.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin by filling out the patient information section. Provide the patient's name, date of birth, sex (choose either male or female), address, city, state, zip code, and phone number.
3. In the clinical information section, input the diagnosis or indication along with any relevant ICD9 code(s). If available, attach family history or any clinical information that could assist in the assessment.
4. Next, move to the specimen information. Enter the patient's medical record or Social Security number.
5. In the billing information section, indicate who the bill should be sent to: hospital, physician, patient, or insurance. Provide the necessary address and contact details.
6. In the individual tests section, answer whether the patient resides in a skilled nursing facility or has been an inpatient in the last week. If your insurance requires pre-authorization for genetic studies, indicate the prior authorization number here.
7. Fill in the ordering physician's details, including name, address, state, zip code, phone, fax, and email. If another copy of the report is needed, include the name and contact information for that physician or facility.
8. Select the tests required by checking the appropriate boxes under individual tests, panel tests, or specimen requirements. Ensure that you provide accurate test specifications if needed.
9. Indicate which facility to ship the specimen to and provide the date and time collected, sample type, and any necessary facility information.
10. Review all fields to ensure accuracy before saving any changes. Finally, you can choose to download, print, or share the completed form.

Complete your document online today for a seamless experience.