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Ataxia Some Panel 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

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How to fill out ataxia exome panel requisition

01

Step 1: Obtain the Ataxia Exome Panel Requisition Form from the testing laboratory.

02

Step 2: Fill out the patient's personal information such as name, date of birth, and contact information.

03

Step 3: Provide the patient's clinical history and any relevant medical information that may assist in the interpretation of the results.

04

Step 4: Specify the reason for the test and any specific features or symptoms that are observed in the patient.

05

Step 5: Indicate the type of sample being submitted (e.g., blood, saliva, or tissue) along with the date of collection.

06

Step 6: Include the name and contact information of the referring physician or healthcare provider.

07

Step 7: Provide any relevant insurance or billing information if required.

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Step 8: Review the completed form for accuracy and ensure all mandatory fields are filled out.

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Step 9: Submit the filled out Ataxia Exome Panel Requisition Form along with the patient's sample to the testing laboratory by following their specified submission process.

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Step 10: Keep a copy of the filled out form for your records.

Who needs ataxia exome panel requisition?

01

Individuals suspected or diagnosed with ataxia or related disorders may require an Ataxia Exome Panel Requisition.

02

Physicians or healthcare providers who suspect a genetic cause of ataxia in their patients may need to submit this requisition form.

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What is ataxia exome panel requisition?

Ataxia exome panel requisition is a form used to request genetic testing for ataxia-related disorders.

Who is required to file ataxia exome panel requisition?

Medical professionals, such as genetic counselors or neurologists, are typically required to file ataxia exome panel requisition forms on behalf of their patients.

How to fill out ataxia exome panel requisition?

To fill out an ataxia exome panel requisition form, medical professionals must provide patient information, relevant medical history, and reason for requesting genetic testing.

What is the purpose of ataxia exome panel requisition?

The purpose of ataxia exome panel requisition is to identify genetic mutations that may be causing ataxia symptoms in patients.

What information must be reported on ataxia exome panel requisition?

Information such as patient demographics, family history of ataxia, and any previous genetic testing results must be reported on ataxia exome panel requisition forms.

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