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CANCER TEST REQUISITION FORM Phylogenetic Laboratories Indiana University School of Medicine 975 W. Walnut, IB 350, Indianapolis, IN 46202 317/2742243 (Office) 317/2781616 (Fax)Patient Laboratory

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How to fill out cancer cytogenetic test requisition

01

Step 1: Obtain a cancer cytogenetic test requisition form from your healthcare provider or laboratory.

02

Step 2: Fill out the patient information section of the requisition form, including your full name, date of birth, and contact information.

03

Step 3: Provide relevant medical history and clinical information, such as previous cancer diagnoses, treatments, and any family history of genetic disorders.

04

Step 4: Indicate the specific type of cancer for which the cytogenetic test is being requested.

05

Step 5: Include any additional instructions or questions you may have for the laboratory or healthcare provider.

06

Step 6: Sign and date the requisition form, indicating consent for the test.

07

Step 7: Submit the completed requisition form to the designated laboratory or healthcare provider for processing.

Who needs cancer cytogenetic test requisition?

01

Individuals who have been diagnosed with cancer and require further analysis of the cancer cells at the genetic level often need a cancer cytogenetic test requisition.

02

Oncologists, hematologists, and other healthcare providers may also request a cancer cytogenetic test requisition to better understand a patient's cancer and guide treatment decisions.

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What is cancer cytogenetic test requisition?

Cancer cytogenetic test requisition is a form or request submitted to order a genetic test to analyze the chromosomes of cancer cells.

Who is required to file cancer cytogenetic test requisition?

Oncologists, pathologists, or other healthcare providers involved in the diagnosis and treatment of cancer patients are required to file cancer cytogenetic test requisition.

How to fill out cancer cytogenetic test requisition?

To fill out the cancer cytogenetic test requisition, healthcare providers need to provide patient information, reason for the test, and any relevant clinical history.

What is the purpose of cancer cytogenetic test requisition?

The purpose of cancer cytogenetic test requisition is to identify genetic abnormalities in cancer cells that can help guide treatment decisions and prognosis.

What information must be reported on cancer cytogenetic test requisition?

Patient demographics, clinical history, reason for the test, and any specific instructions for the genetic testing lab must be reported on cancer cytogenetic test requisition.

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