Get the free Dermatopathology Consultation Requisition Form - alvernoclinicallabs

Dermatopathology Consultation Requisition Form 2434 Interstate Plaza Drive, Hammond, IN 46324 Tel: 2199893819 Fax: 2198454088 Referring Physician Name NPI# Address City State Zip Phone Fax Email Patient

How to fill out dermatopathology consultation requisition form

How to Fill Out Dermatopathology Consultation Requisition Form:

1. Begin by entering your personal information, such as your name, contact details, and any identifying numbers or codes provided by your healthcare provider.
2. Provide details about the patient, including their name, date of birth, and any relevant medical history or symptoms that prompted the need for a dermatopathology consultation.
3. Indicate the primary reason for the consultation, whether it is to confirm a diagnosis, assess a treatment plan, or provide additional information for a patient's ongoing care.
4. Specify the type of specimen or biopsy that is being submitted for evaluation, such as a skin biopsy, excisional biopsy, or punch biopsy.
5. Include relevant clinical information, such as the location of the biopsy site, its size, and any accompanying clinical photographs or imaging studies.
6. If applicable, provide information regarding any specific tests or stains that should be performed on the specimen, as requested by the healthcare provider.
7. Enter the referring physician's information, including their name, contact details, and any additional pertinent information about their involvement in the patient's care.
8. If necessary, indicate any special instructions or considerations, such as if the results are urgently needed or if there are any specific concerns or questions that should be addressed by the dermatopathologist.
9. Finally, review the completed form for accuracy and ensure that all necessary sections have been filled out before submitting it to the appropriate healthcare facility or laboratory for processing.

Who Needs Dermatopathology Consultation Requisition Form?

1. Patients who have undergone skin biopsies or have skin lesions that require further evaluation often need to fill out a dermatopathology consultation requisition form.
2. Dermatologists, physicians, or healthcare providers who are seeking consultation from a dermatopathologist regarding the diagnosis, treatment plan, or management of a patient's skin condition would need this form.
3. Laboratories or healthcare facilities that receive and process dermatopathology consultation requests require this form to ensure that all necessary information is provided and to facilitate proper communication between the referring physician and the dermatopathologist.

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