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Cancer Requisition Form The University of Chicago Genetic Services Laboratories 5841 South Maryland Avenue, Room G701/MC0077, Chicago, IL 60637 Toll Free: 888.824.3637 Local: 773.834.0555 Fax: 773.702.9130
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How to fill out cancer requisition form
How to fill out cancer requisition form
01
First, obtain a cancer requisition form from a healthcare provider or hospital.
02
Read the instructions carefully before filling out the form.
03
Provide your personal information such as name, address, and contact details in the designated fields.
04
Specify the type of cancer test or screening you require.
05
Include relevant medical history and any previous cancer diagnoses, if applicable.
06
Indicate the preferred healthcare facility where you want the test to be conducted.
07
If necessary, provide insurance or payment information.
08
Review the completed form for accuracy and ensure all required sections are filled out.
09
Submit the cancer requisition form to the healthcare provider or hospital.
10
Follow any additional instructions provided by the healthcare provider regarding the test or screening.
Who needs cancer requisition form?
01
Individuals who suspect they may have cancer and wish to undergo diagnostic testing.
02
Patients who have been referred by a doctor for further evaluation or screening.
03
People who have a family history of cancer and want to monitor their own health.
04
Individuals participating in cancer research studies or clinical trials.
05
Those who are concerned about specific symptoms or potential risk factors for cancer.
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What is cancer requisition form?
Cancer requisition form is a document used to request information about a patient's cancer diagnosis and treatment.
Who is required to file cancer requisition form?
Medical professionals, such as doctors and oncologists, are required to file cancer requisition forms.
How to fill out cancer requisition form?
To fill out a cancer requisition form, the medical professional must provide detailed information about the patient's diagnosis, treatment, and medical history.
What is the purpose of cancer requisition form?
The purpose of a cancer requisition form is to gather and document important information about a patient's cancer diagnosis and treatment.
What information must be reported on cancer requisition form?
The information reported on a cancer requisition form includes the patient's name, date of birth, cancer diagnosis, treatment plan, and medical history.
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