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CANCER PHYLOGENETIC STUDY REQUISITION FOR CHG LAB USE ONLY: Date received: Time: Lab #: Center for Human Genetics, Inc. Riverside Technology Center 840 Memorial Drive, Suite 101 Cambridge, MA 02139
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How to fill out cancer cytogenetic study requisition:

01
Start by providing your personal information such as your name, date of birth, and contact information. This will ensure that the results of the study are accurately attributed to you.
02
Next, indicate the reason for the cytogenetic study requisition. Specify the type of cancer that is being investigated and any relevant medical history that may influence the study.
03
Mention the healthcare provider or physician who has recommended this study. Include their name, contact information, and any other details that may be required.
04
Specify the type of sample that will be submitted for the study. Common samples include blood, bone marrow, or tissue samples. Provide details such as the date the sample was collected, the name of the hospital or laboratory where it was collected, and any special instructions for handling the sample.
05
Include any relevant insurance information if applicable. This may include your insurance provider, policy number, and any other necessary details.
06
Sign and date the requisition form to confirm your consent and understanding of the study.

Who needs cancer cytogenetic study requisition?

01
Individuals who have been diagnosed with cancer and require further investigation into the genetic abnormalities associated with their cancer cells.
02
Healthcare providers or physicians who suspect a genetic or chromosomal cause for the development or progression of cancer in their patients.
03
Research institutions or laboratories conducting studies on cancer genetics and requiring samples for analysis and research purposes.
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The cancer cytogenetic study requisition is a form used to request a cytogenetic study to analyze the chromosomes of cancer cells.
Oncologists, hematologists, and other healthcare providers involved in the care of cancer patients are required to file the cancer cytogenetic study requisition.
The cancer cytogenetic study requisition should be filled out with the patient's information, type of cancer, reason for the study, and any specific instructions for the cytogenetic analysis.
The purpose of the cancer cytogenetic study requisition is to help healthcare providers determine the genetic abnormalities present in cancer cells, which can inform treatment decisions.
The cancer cytogenetic study requisition must include the patient's name, date of birth, medical record number, type of cancer, reason for the study, and any specific instructions for the cytogenetic analysis.
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