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CANCER TEST REQUISITION FORM Phylogenetic Laboratories Indiana University School of Medicine 975 West Walnut St., IB264 Indianapolis, IN 46202 317/274-2243 (Office) 317/278-1616 (Fax) 317/274-1054
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How to fill out IU School of Medicine Cancer Test Requisition Form

01
Obtain a copy of the IU School of Medicine Cancer Test Requisition Form.
02
Fill in the patient's personal details including name, date of birth, and contact information.
03
Provide the physician's information, including name, contact number, and signature.
04
Indicate the specific tests required by checking the appropriate boxes on the form.
05
Include any relevant patient medical history that might aid in processing the tests.
06
Make sure to sign and date the form at the designated area.
07
Submit the completed form along with the specimen to the laboratory as instructed.

Who needs IU School of Medicine Cancer Test Requisition Form?

01
Patients who require cancer testing.
02
Physicians referring patients for cancer tests.
03
Healthcare providers involved in the diagnosis and treatment of cancer.
04
Research organizations conducting cancer studies that require testing.
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Lung and bronchus cancer is responsible for the most deaths with 130,180 people expected to die from this disease. That is nearly three times the 52,580 deaths due to colorectal cancer, which is the second most common cause of cancer death. Pancreatic cancer is the third deadliest cancer, causing 49,830 deaths.

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The IU School of Medicine Cancer Test Requisition Form is a document used to request laboratory tests related to cancer diagnosis and treatment.
Healthcare providers, such as physicians or oncologists, are required to file the IU School of Medicine Cancer Test Requisition Form when ordering cancer-related tests for their patients.
To fill out the IU School of Medicine Cancer Test Requisition Form, complete the required patient information, select the appropriate tests needed, provide clinical details, and sign the form before submission.
The purpose of the IU School of Medicine Cancer Test Requisition Form is to ensure proper tracking, testing, and reporting of cancer-related diagnostic tests in order to facilitate accurate patient care.
The information that must be reported on the IU School of Medicine Cancer Test Requisition Form includes patient demographics, clinical history, test requests, and any pertinent medical information relevant to the cancer tests.
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