Get Canada Mitogendx Outside Of Alberta Test Requisition Form 2023-2025

Filling out the Canada MitogenDx Outside Of Alberta Test Requisition Form online is a straightforward process designed to ensure all necessary information is collected for efficient processing. This guide will walk you through each section of the form, providing clear instructions to help you complete it accurately.

Follow the steps to complete the test requisition form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the Patient Information section. Include the patient's full name (surname, first name), date of birth, gender, personal health number, and contact information. Ensure all details are accurate to avoid processing delays.
3. Next, proceed to the Referring Physician Information section. Enter the name of the referring physician, their phone number, fax number, and email address. This information is essential for test result communication.
4. Fill out the Referring Laboratory Information. Provide the name and address of the referring laboratory along with their contact information, including phone number, fax number, and email. This step is crucial for invoice processing.
5. In the Sample Information section, indicate the sample type by selecting from options such as serum, plasma, or cerebrospinal fluid (CSF). Also, record the time and date the sample was collected.
6. Choose the Billing Options and Receiving Results. Select either Option A or B to indicate how the payment will be processed, and provide relevant information based on your selection.
7. If you selected Option B, make sure to include the customer's name, contact information, and consent for results to be sent directly to the customer email provided.
8. Review all entered information for accuracy and completeness. Make any necessary corrections before proceeding.
9. Upon completion, users can save changes, download, print, or share the form as required.

Complete your documents online today and ensure a smooth submission process.