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Patient Last Name: MICROBIOLOGY LABORATORYFirst Name:555 University Avenue Room 3676, Atrium Toronto, ON, M5G 1×8, Candidate of Birth (DD/MM/YYY): Gender:Tel: 4168136000 Fax: 4168135993MaleFemaleFor
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How to fill out quantiferon tb req ext11
How to fill out quantiferon tb req ext11
01
To fill out the Quantiferon TB Req Ext11 form, follow these steps:
1. Start by entering the patient's full name, date of birth, and gender in the designated fields.
02
Provide the patient's contact information, including their phone number and address, so that they can be reached for any follow-up communication.
03
Indicate the date of the blood draw or collection date for the specimen in question.
04
Specify the referring provider's information, including name, address, and contact details.
05
Enter the relevant clinical information, such as any symptoms or risk factors observed, medical history, and current medications.
06
If applicable, provide details of any previous tuberculosis (TB) tests done and their results.
07
If the test is being done for occupational health purposes, indicate the patient's job title and employer's name.
08
Finally, ensure all the information provided is accurate and complete before submitting the form.
Who needs quantiferon tb req ext11?
01
Quantiferon TB Req Ext11 form is needed for patients who are being tested for tuberculosis (TB) infection or who require further evaluation for TB diagnosis.
02
This form is typically used by healthcare providers or laboratories to request a Quantiferon TB Gold Plus test, which is a blood test used to aid in the diagnosis of TB infection.
03
Patients who have symptoms or risk factors associated with TB, such as persistent cough, fever, weight loss, exposure to TB-infected individuals, or recent travel to high TB-burden areas may require this test.
04
Additionally, individuals who may be at increased risk of TB due to their occupation, such as healthcare workers or laboratory staff, may also need to undergo this test.
05
It is important to consult with a healthcare provider to determine if the Quantiferon TB Gold Plus test is necessary and to obtain the Quantiferon TB Req Ext11 form.
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What is quantiferon tb req ext11?
Quantiferon tb req ext11 is a form used for requesting a Quantiferon TB test, which is a blood test used to detect latent tuberculosis infection.
Who is required to file quantiferon tb req ext11?
Healthcare providers or facilities that require patients to undergo a Quantiferon TB test.
How to fill out quantiferon tb req ext11?
The form should be filled out by providing patient information, test request details, and any relevant clinical information.
What is the purpose of quantiferon tb req ext11?
The purpose of the form is to request a Quantiferon TB test in order to detect latent tuberculosis infection.
What information must be reported on quantiferon tb req ext11?
Patient demographic information, test request details, and any relevant clinical information.
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