Get the free COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity

This document is a test request form and statement of medical necessity for genetic testing related to colorectal cancer and adenomatous polyposis syndromes.

How to fill out colaris colaris ap test

How to fill out COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity

1. Start by obtaining the COLARIS® / COLARIS AP® Test Request Form.
2. Fill in the patient's personal information including name, date of birth, and contact details.
3. Indicate the reason for the test by checking the appropriate box related to the patient's medical history.
4. Provide the name of the referring physician and their contact information.
5. Complete the sections for the patient's clinical information and any relevant family history.
6. Sign and date the form to verify the accuracy of the information provided.
7. Attach an appropriate Statement of Medical Necessity that outlines the justification for testing.
8. Submit the completed form to the designated laboratory or physician's office.

Who needs COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity?

1. Patients with a family history of certain genetic conditions.
2. Individuals exhibiting clinical symptoms suggestive of hereditary cancer risk.
3. Healthcare providers seeking genetic evaluation for their patients.
4. Insurance companies requiring documentation for coverage of genetic testing.

For pdfFiller’s FAQs

What is COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity?

The COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity is a document used by healthcare providers to request genetic testing services. It includes a medical justification for the test, ensuring that the test is clinically appropriate for the patient.

Who is required to file COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity?

Healthcare providers, such as physicians or medical practitioners, who are ordering the COLARIS® or COLARIS AP® genetic tests are required to file the COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity.

How to fill out COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity?

To fill out the COLARIS® / COLARIS AP ® Test Request Form, healthcare providers must provide patient demographic information, select the appropriate test, detail the medical necessity justifications, and sign the form to authenticate the request.

What is the purpose of COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity?

The purpose of the COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity is to ensure that genetic testing is warranted based on the patient’s clinical circumstances and to provide documentation that supports the need for the test from a medical standpoint.

What information must be reported on COLARIS® / COLARIS AP ® Test Request Form and Statement of Medical Necessity?

The COLARIS® / COLARIS AP ® Test Request Form must report patient information such as name, contact details, insurance information, the test being requested, clinical indications for testing, and the provider's signature, as well as any relevant medical history.