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Test Requisition Fax: 8322993110 *Denotes required Information Ordering Physician Information *Institution Name Additional physician’s) to be Copied: *Ordering Physician Name *Physician NPI Number

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How to fill out test requisition - home

How to fill out test requisition - home:

01

Gather all necessary information: Before filling out the test requisition form, make sure you have all the required information. This may include personal details such as name, address, date of birth, and contact information, as well as any specific instructions provided by the testing facility.

02

Patient information: Enter your personal details accurately in the designated fields. This will help ensure that the test results are attributed to the correct individual.

03

Insurance information (if required): If your test is covered by insurance, you may need to provide your insurance information. This can include the name of your insurance provider, policy number, and any other relevant details.

04

Test details: Specify the type of test you are requesting. This could be a COVID-19 test, blood test, genetic test, or any other specific test. Provide any additional information or instructions related to the test, if necessary.

05

Date and location: Indicate the preferred date and location for the test. If you are opting for a home test, mention that you would like the test to be conducted at your residence.

06

Consent and signature: Read through the consent section carefully, ensuring you understand the terms and conditions of the test. If you agree, sign and date the requisition form. By signing, you are giving your consent for the test to be conducted.

Who needs test requisition - home?

01

Individuals with limited mobility: Home test requisitions are particularly useful for individuals who have difficulty traveling to testing facilities due to limited mobility or other physical constraints. It allows them to get tested conveniently from the comfort of their own homes.

02

Individuals in quarantine or self-isolation: For individuals who are required to quarantine or self-isolate due to potential exposure to contagious diseases like COVID-19, a home test requisition provides a safe and efficient way to get tested without risking the spread of the infection to others.

03

Those in remote areas: Home test requisitions can be beneficial for individuals residing in remote or rural areas, where access to testing facilities may be limited. By opting for a home test, they can ensure timely testing without the need for traveling long distances.

04

Individuals seeking convenience and privacy: Some people may simply prefer the convenience and privacy of getting tested at home. This is especially true for tests that may involve collecting samples, such as urine or stool samples, which some individuals may find more comfortable to do in the privacy of their own homes.

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What is test requisition - home?

Test requisition - home is a form or application requesting a test to be conducted at home.

Who is required to file test requisition - home?

Individuals who need to get tested at home are required to file a test requisition - home.

How to fill out test requisition - home?

To fill out a test requisition - home, one needs to provide personal information, testing details, and any other required information.

What is the purpose of test requisition - home?

The purpose of test requisition - home is to request a test to be conducted at the individual's home for convenience.

What information must be reported on test requisition - home?

Information such as personal details, test details, contact information, and any specific instructions must be reported on test requisition - home.

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