Follow the steps to complete your requisition form online.

1. Click ‘Get Form’ button to obtain the necessary document and open it in your editor.
2. Begin by entering the patient's name in the designated fields, including the last name and first name.
3. Input the medical record number and date of birth in the appropriate sections.
4. Indicate the patient's sex by selecting M or F.
5. Attach a demographic label or fill in all required patient information fields.
6. Provide the contact information for the ordering physician, including their name, address, and phone number.
7. Have the ordering physician sign and date the form in the designated area.
8. Indicate collection date and specimen draw time, along with the type of specimen collected.
9. Fill out the pertinent patient information and family history as needed, including any known familial mutations.
10. Select the tests being requested by marking your choices clearly, ensuring all necessary sections are completed.
11. Finally, review all entered information for accuracy, then save, download, print, or share the completed form as needed.

Complete your UCLA DNA Repair Clinical Testing Laboratory Requisition Form 1 online today for efficient processing.