Get the free BRCA Test Requisition - BRCAvantage

ACCOUNT #: NAME: ADDRESS: CITY, STATE, ZIP TELEPHONE #: DATE COLLECTED TIME : AM TOTAL VOL×HRS. PM ML I.D.# NAME Fax Results to: () M PATIENT SOCIAL SECURITY # D Patient Service Center location and

How to fill out brca test requisition

How to fill out a BRCA test requisition:

1. Obtain the requisition form: Start by requesting the BRCA test requisition form from a healthcare provider or laboratory that offers genetic testing services. This form is necessary to initiate the testing process.
2. Provide personal information: Fill out the required personal information on the requisition form. This typically includes your full name, date of birth, gender, and contact information. Ensure that you provide accurate and up-to-date details.
3. Specify medical history: Provide a brief overview of your personal or family medical history that might be relevant for the BRCA test. Indicate any known instances of breast or ovarian cancer, as well as any other related cancers in your family.
4. Detail insurance information: If you have health insurance, include your insurance details on the form. This may include your insurance provider, policy number, and any other relevant information. If you don't have insurance or are using a different payment method, indicate that on the form as well.
5. Select testing options: Choose the desired testing options based on your healthcare provider's recommendation or your individual needs. The requisition form usually provides checkboxes or spaces to specify the BRCA1 and BRCA2 genes to be tested, as well as any additional genetic markers that may be relevant. Indicate any specific requests or preferences, if applicable.
6. Consent and signature: Read the consent section carefully. This portion acknowledges your understanding of the testing process, potential risks and limitations, and your consent to undergo the test. Sign and date the requisition form to finalize your consent.
7. Delivery or submission: Depending on the specific instructions provided by the healthcare provider or laboratory, you may need to return the completed requisition form by mailing it, dropping it off directly at the laboratory, or submitting it through an online portal, if available. Follow the specified instructions to ensure proper delivery.

Who needs a BRCA test requisition:

1. Individuals with a family history of breast or ovarian cancer: BRCA testing is often recommended for individuals who have a family history of these specific cancers. If you have close relatives, such as a parent, sibling, or child, who have been diagnosed with breast or ovarian cancer, you may be at higher risk and could benefit from genetic testing.
2. Individuals with a personal history of breast or ovarian cancer: If you have a history of breast or ovarian cancer, especially at a young age, your healthcare provider may recommend BRCA testing to assess your genetic predisposition for these cancers. This information can help inform treatment options, prevention strategies, and potential risks for other family members.
3. Individuals with ancestry associated with a higher risk: Certain ethnicities, such as Ashkenazi Jewish descent, have a higher prevalence of BRCA mutations. If you belong to one of these groups, your healthcare provider may consider BRCA testing, even in the absence of a strong family history or personal cancer diagnosis.

It is important to consult with a healthcare professional or a genetic counselor who can evaluate your specific situation and guidelines to determine if a BRCA test requisition is appropriate for you.

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What is brca test requisition?

The BRCA test requisition is a form that is used to request testing for BRCA gene mutations.

Who is required to file brca test requisition?

Healthcare providers or genetic counselors are required to file the BRCA test requisition.

How to fill out brca test requisition?

To fill out the BRCA test requisition, healthcare providers must provide patient information, clinical history, and reason for testing.

What is the purpose of brca test requisition?

The purpose of the BRCA test requisition is to determine if an individual carries mutations in the BRCA1 or BRCA2 genes, which can increase the risk of certain cancers.

What information must be reported on brca test requisition?

The BRCA test requisition must include patient demographics, family history of cancer, and other relevant clinical information.