Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Nj Lab-10 2014

Get Nj Lab-10 2014-2026

(QFT-IT) CLIA #31D0881184 Fill out form completely. Please print clearly. Send with each set of samples. PATIENT INFORMATION (REQUIRED) First Name Last Name Address City State Chart Number or Other ID (Required) Date of Birth Gender Male Female Race STATUS OF PATIENT Zip Code / / Reason for QFT-IT Initial Test? Yes No 1 Asian 1 Case/Suspect Repeated Test? Yes No 2 Black/African American 2 Foreign-born, Less than 5 years in USA Previous positive PPD? Whe.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the NJ LAB-10 online

Filling out the NJ LAB-10 form online is a straightforward process that requires attention to detail. This guide provides step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the NJ LAB-10 form online.

  1. Click the ‘Get Form’ button to access the NJ LAB-10 form and open it in your browser.
  2. Begin by completing the patient information section. Fill in the first and last name, address, city, state, zip code, date of birth, and gender details. Ensure to use clear, legible handwriting if applicable.
  3. Provide the patient’s race by checking the appropriate box and note their status, including the reason for the Quantiferon-TB Gold test and any prior positive PPD tests.
  4. In the decision fields regarding the test, indicate if this is an initial or repeated test. Additionally, answer questions about exposure to MTB and whether the patient is immunocompromised.
  5. Complete the specimen information section with the dates and times of collection and incubation, along with the initials of the person who collected the sample.
  6. In the submitter/requester information area, fill out the site number, provider details, and contact information, ensuring the attention and fax fields are filled in as needed.
  7. Obtain the ordering physician's signature and date the form appropriately.
  8. After filling out all sections, review the form for accuracy before saving your changes. You may then download, print, or share the completed form as needed.

Complete your NJ LAB-10 form online today to ensure timely processing of your request.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

REQUEST FOR QUANTIFERON-TB GOLD TEST IN-TUBE ...
Trenton, NJ 08625-0361. REQUEST FOR QUANTIFERON-TB GOLD. TEST IN-TUBE METHOD (QFT-IT)...
Learn more
N.J. Admin. Code § 10:61-1.6 - Orders for...
(a) All orders for clinical laboratory services shall be in the form of an explicit order...
Learn more
Applied Millers of Wyckoff Inc. Wyckoff NJ 483...
Jul 16, 2015 — This document lists observations made by the FDA representative(s) during...
Learn more

Related links form

FL 12.913(a)(2) 2015 FL 12.913(b) 2012 FL 12.913(b) 2000 FL 12.913(c) 2012

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

QuantiFERON-TB Gold+ for the Diagnosis of Mycobacterium tuberculosis Infection TestIndicationCost* QuantiFERON-TB Gold+ Diagnosis of latent or active tuberculosis infection $32 to $189 Feb 1, 2021

QuantiFERON-TB Gold (QFT) is a simple blood test that aids in the detection of Mycobacterium tuberculosis, the bacteria which causes tuberculosis (TB). QFT is an -gamma (IFN-γ) release assay, commonly known as an IGRA, and is a modern alternative to the tuberculin skin test (TST, PPD or Mantoux).

QuantiFERON-TB Gold PLUS (QFT-PLUS) was developed as a new version of the -γ (IFN-γ) release assay that contains an extra antigen tube to elicit a CD8+ T-cell response in addition to a CD4+ T-cell response.

The QuantiFERON-TB Gold Plus (QFT-Plus), also known as an gamma release assay (IGRA), is an in vitro diagnostic test that utilizes a peptide cocktail simulating ESAT-6 and CFP-10 proteins to stimulate cells in heparinized whole blood.

The Quantiferon-TB Gold test (QFT-G) is a whole-blood test that helps in detecting Mycobacterium tuberculosis infection, latent tuberculosis infection (LTBI) and tuberculosis (TB) disease.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get NJ LAB-10
Get form
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
  • Real Estate Handbook
  • All Guides
  • Notarize
  • Incorporation services
  • For Consumers
  • For Small Business
  • For Attorneys
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Form Packages
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
Form Categories
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
Customer Service
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
Legal Guides
  • Real Estate Handbook
  • All Guides
Prepared for you
  • Notarize
  • Incorporation services
Our Customers
  • For Consumers
  • For Small Business
  • For Attorneys
Our Sites
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
© Copyright 1999-2026 airSlate Legal Forms, Inc. 3720 Flowood Dr, Flowood, Mississippi 39232
  • Your Privacy Choices
  • Terms of Service
  • Privacy Notice
  • Content Takedown Policy
  • Bug Bounty Program