Get the free EPILEPSY EXOME REQUISITION FORM - dnatesting uchicago

EPILEPSY SOME REQUISITION From 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:

How to fill out epilepsy exome requisition form

How to fill out epilepsy exome requisition form

1. Obtain a copy of the epilepsy exome requisition form from the designated source.
2. Fill out the patient information section, providing details such as name, date of birth, and gender.
3. Include the contact information of the referring physician or healthcare provider.
4. Specify the reason for ordering the epilepsy exome test and provide relevant clinical details.
5. Indicate any specific genes or variants of interest, if applicable.
6. Select the preferred billing option and provide insurance details, if necessary.
7. Ensure all required fields are completed and double-check for any errors or omissions.
8. Sign and date the form to validate the information provided.
9. Submit the completed epilepsy exome requisition form along with any supporting documentation as required.
10. Follow the designated procedure for submitting the form, whether it is through mail, fax, or electronic submission.

Who needs epilepsy exome requisition form?

1. Individuals suspected or diagnosed with epilepsy who require further genetic testing to identify potential underlying genetic causes or variants.

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What is epilepsy exome requisition form?

The epilepsy exome requisition form is a document used to request genetic testing for epilepsy related genes.

Who is required to file epilepsy exome requisition form?

Individuals who suspect they or their family members may have epilepsy or a genetic predisposition to epilepsy are required to file the epilepsy exome requisition form.

How to fill out epilepsy exome requisition form?

To fill out the epilepsy exome requisition form, one must provide personal information, medical history, and reasons for requesting genetic testing for epilepsy.

What is the purpose of epilepsy exome requisition form?

The purpose of epilepsy exome requisition form is to facilitate the process of genetic testing for individuals suspected of having epilepsy or a genetic predisposition to epilepsy.

What information must be reported on epilepsy exome requisition form?

Information such as personal details, medical history, family history of epilepsy, and specific genes to be tested must be reported on the epilepsy exome requisition form.