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Page 1 of 2Patient Name: Identification Number: HEREDITARY CANCER PANEL REQUISITION FORM ROUTE SAMPLE TO UPMC MAGEEWOMENS HOSPITAL CYTOGENETICS RM 1217 VIA MEDIATED COURIER FORM MUST BE ENCLOSED WITH
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How to fill out hereditary cancer panel requisition

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How to fill out hereditary cancer panel requisition

01
Step 1: Obtain the hereditary cancer panel requisition form from a healthcare provider or a genetic testing laboratory.
02
Step 2: Read and understand the instructions provided on the requisition form before filling it out.
03
Step 3: Provide your personal information, including your full name, date of birth, and contact information.
04
Step 4: Indicate the reason for the testing, such as a family history of cancer or a known genetic mutation.
05
Step 5: Specify the type of hereditary cancer panel you are requesting, if applicable.
06
Step 6: Include relevant medical and family history information, such as previous cancer diagnoses in your family.
07
Step 7: Sign and date the requisition form, acknowledging your consent for the genetic testing.
08
Step 8: Submit the completed requisition form to the genetic testing laboratory either in person or by mail, as per their instructions.

Who needs hereditary cancer panel requisition?

01
Individuals with a personal or family history of cancer may need a hereditary cancer panel requisition.
02
People who have relatives with a known genetic mutation associated with cancer may also require a requisition for this panel.
03
Those who want to assess their risk for developing certain types of cancer, especially if they have a family history, can benefit from a hereditary cancer panel test.
04
Healthcare providers may recommend a hereditary cancer panel requisition for patients who meet specific criteria based on their medical history and family background.
05
Ultimately, the decision of who needs a hereditary cancer panel requisition should be made in consultation with a healthcare professional or a genetic counselor.
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Hereditary cancer panel requisition is a medical test that evaluates an individual's risk of developing cancer based on their family history and genetic factors.
Individuals with a family history of cancer or those with certain genetic mutations are typically required to file a hereditary cancer panel requisition.
Hereditary cancer panel requisition can be filled out by a healthcare provider who will collect relevant information about the individual's medical history and family history.
The purpose of hereditary cancer panel requisition is to assess an individual's risk of developing cancer and to guide recommendations for screening, prevention, and treatment.
Information such as personal medical history, family history of cancer, and any known genetic mutations must be reported on hereditary cancer panel requisition.
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