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BAYLOR GENETICS 2450 HOLCOMBE BLVD. GRAND BLVD. RECEIVING DOCK HOUSTON, TX 770212024PHONE 1.800.411.4363 FAX 1.800.434.9850CONNECTMOLECULAR DIAGNOSTIC TESTING REQUISITION PATIENT INFORMATION (COMPLETE

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How to fill out molecular diagnostic testing requisition

01

Step 1: Obtain the molecular diagnostic testing requisition form from the testing facility or healthcare provider.

02

Step 2: Fill out your personal information accurately, including your full name, date of birth, and contact information.

03

Step 3: Provide relevant medical information, such as your medical history, current symptoms, and any known genetic conditions in your family.

04

Step 4: Indicate the specific type of molecular diagnostic testing you are requesting, along with any additional tests or panels.

05

Step 5: Include the name and contact information of your healthcare provider who will receive the test results.

06

Step 6: Read and sign any necessary consent forms or waivers required by the testing facility or healthcare provider.

07

Step 7: Ensure you have provided all necessary supporting documents, such as insurance information or a referral from your healthcare provider.

08

Step 8: Double-check all the information you have provided for accuracy and completeness.

09

Step 9: Submit the completed molecular diagnostic testing requisition form to the testing facility or healthcare provider as instructed.

10

Step 10: Follow up with the testing facility or healthcare provider to confirm receipt of the requisition form and to inquire about the estimated turnaround time for test results.

Who needs molecular diagnostic testing requisition?

01

Individuals who suspect they may have a genetic condition or are at risk for certain diseases may need to fill out a molecular diagnostic testing requisition form.

02

Healthcare providers may also complete these requisition forms for their patients to request specific genetic tests or screening panels.

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