Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form 2015 free printable template

CONSTITUTIONAL (BLOOD) TEST REQUISITION FORM Phylogenetic Laboratories Indiana University School of Medicine 975 West Walnut St., #264 Indianapolis, IN 46202 317/2742243 (Office) 317/2781616 (Fax)Patient

How to fill out Cytogenetic Laboratories Constitutional Blood Test Requisition

How to fill out Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form

1. Obtain the Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form from the laboratory or download it from their website.
2. Fill in the patient's personal information, including name, date of birth, and contact information.
3. Provide details of the referring physician, including their name, contact number, and any specific instructions.
4. Indicate the type of test requested by marking the appropriate section of the form.
5. If applicable, provide insurance information and any authorization necessary for testing services.
6. Include any clinical information or patient history that may aid in the interpretation of the results.
7. Review the completed form for accuracy and sign where required, confirming the information is correct.
8. Submit the form along with the blood sample to the laboratory.

Who needs Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form?

1. Patients undergoing genetic testing for inherited disorders or chromosomal abnormalities.
2. Referring physicians needing to assess genetic conditions or provide a diagnosis.
3. Individuals with a family history of genetic conditions seeking information on potential risks.

People Also Ask about

Which of the following container is ideal for peripheral blood specimen for cytogenetic examination?

Collection of Specimens for Cytogenetic Analysis Peripheral Blood for Chromosome and/or FISH Analysis: Dark Green-top Sodium heparin tubes. Collect 2-10 mL of blood into dark green-top sodium heparinized tubes (2-4 mL for infants; 7-10 mL for adults).

How long does cytogenetic testing take?

Preliminary results available in one to two weeks if requested; final results in 14-21 days (prenatal) or 30 days (pediatric)

What is the preferred specimen for cytogenetics study?

Specimen Collection A cytogenetic test can be obtained for fetal diagnostic testing as early as 10 weeks of gestation from chorionic villus sampling (CVS), using trophoblast cells or cultured mesenchymal cells.

What specimens are used for chromosomal studies?

Cells for chromosome analysis can come from a blood sample, from inside a bone (bone marrow sample), from a swab of cells taken from inside your mouth, or from a sample of your skin or hair. Cells can also be taken from the fluid that surrounds a baby inside a mother's uterus (amniocentesis).

What color tube is used for cytogenetics?

The specimen collection tube of choice for whole blood or bone marrow cytogenetics is Dark Green Sodium Heparin kept at Room Temperature.

Can you do cytogenetics on peripheral blood?

Background: Peripheral blood (PB) is sometimes used in place of bone marrow (BM) for cytogenetic studies during the evaluation of hematologic malignancies.

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What is Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form?

The Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form is a document used to request genetic testing on blood samples for the purpose of diagnosing and assessing genetic disorders.

Who is required to file Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form?

The form is typically required to be filed by healthcare providers such as physicians or specialists who are ordering genetic tests for their patients.

How to fill out Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form?

To fill out the form, the healthcare provider must provide patient information, including name, date of birth, and relevant medical history, along with the specific tests being requested and any clinical information necessary for interpretation.

What is the purpose of Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form?

The purpose of the form is to facilitate the process of obtaining genetic testing by providing essential information that ensures accurate testing and interpretation of results.

What information must be reported on Cytogenetic Laboratories Constitutional (Blood) Test Requisition Form?

The form must report patient demographic details, the reason for testing, clinical history, the specific tests requested, and any relevant notes or instructions to guide the laboratory in handling the specimen.