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Cytogenetics Laboratory Requisition Eastern Ontario Regional Genetics Program 401 Smith Road, Rm w3401 Ottawa, ON, K1H 8L1 Tel: (613) 7372554 Fax: (613) 7384814 http://www.cheo.on.ca (under Programs

How to fill out cheo cytogenetics laboratory requisition

How to Fill out CHEO Cytogenetics Laboratory Requisition:

Start by providing your personal information:

1. Fill in your full name, date of birth, and contact information accurately.
2. Include your mailing address and preferred method of communication.

Indicate the reason for the requisition:

1. Specify the medical condition or reason for the cytogenetics test.
2. The requisition form may have checkboxes or fields where you can provide this information.

Provide your healthcare provider's information:

1. Write the name of your referring physician or healthcare provider.
2. Include their contact information, such as their clinic or hospital name.

Include your healthcare number and insurance information:

1. Provide your health insurance information accurately.
2. Include your insurance policy number and any relevant details.

Specify the type of sample to be tested:

1. Indicate the type of specimen you are submitting for testing (e.g., blood, bone marrow, or tissue).
2. If you know any additional details about the sample, such as its source or collection method, include it.

Attach any relevant documentation:

1. If you have any medical reports or test results related to the condition, attach them to the requisition form.
2. These documents can help the laboratory interpret the test results accurately.

Consent and authorization:

1. Read and sign the consent and authorization section if applicable.
2. This demonstrates your understanding of the test and grants permission for the laboratory to perform the analysis.

Submit the requisition form:

1. Ensure that all sections are filled out correctly and legibly.
2. Follow the instructions provided on where to send the completed requisition form.
3. Double-check if there are any additional requirements, such as enclosing a copy of your health card or referral letter.

Who needs CHEO Cytogenetics Laboratory Requisition?

1. Individuals who have been referred by a healthcare provider for cytogenetics testing.
2. Patients with suspected genetic disorders, chromosomal abnormalities, or inherited conditions may require this requisition.
3. People seeking prenatal testing or genetic counseling may also need to fill out the CHEO Cytogenetics Laboratory Requisition.

Note: It is essential to consult with your healthcare provider to determine if you need the CHEO Cytogenetics Laboratory Requisition and to obtain accurate instructions and guidance on filling it out correctly.

For pdfFiller’s FAQs

What is cheo cytogenetics laboratory requisition?

The CHEO Cytogenetics Laboratory requisition is a form used to request cytogenetic testing to analyze chromosomal abnormalities.

Who is required to file cheo cytogenetics laboratory requisition?

Healthcare providers or clinicians who suspect a patient may have a chromosomal abnormality are required to file the CHEO Cytogenetics Laboratory requisition.

How to fill out cheo cytogenetics laboratory requisition?

To fill out the CHEO Cytogenetics Laboratory requisition, healthcare providers must provide patient information, clinical history, and reason for testing, among other required details.

What is the purpose of cheo cytogenetics laboratory requisition?

The purpose of the CHEO Cytogenetics Laboratory requisition is to facilitate the process of requesting and conducting cytogenetic testing to diagnose chromosomal abnormalities.

What information must be reported on cheo cytogenetics laboratory requisition?

Patient demographics, clinical history, reason for testing, referring physician information, and any relevant family history are some of the information that must be reported on the CHEO Cytogenetics Laboratory requisition.

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