Get the free Molecular Diagnostics Request Form http://www - dukemolecular duhs duke

Molecular Diagnostics Request Form http://www.dukemolecular.org DUKE UNIVERSITY HEALTH SYSTEM ? PHONE: (919) 684-2698 ? FAX: (919) 668-9173 DUES Clinical Labs ? 4425 Ben Franklin Blvd ? Room 149A

How to fill out molecular diagnostics request form

How to fill out molecular diagnostics request form?

1. Obtain a copy of the molecular diagnostics request form from the laboratory or medical facility that will perform the testing.
2. Start by providing your personal information such as your full name, date of birth, and contact details in the designated fields.
3. Next, you may be required to provide the referring physician's information, including their name, specialty, and contact details.
4. Specify the type of molecular diagnostics test you are requesting by selecting the appropriate option from the provided list or by writing it in a designated space.
5. If applicable, provide any relevant medical history or clinical information that might assist the laboratory in conducting the test accurately.
6. Indicate your preferred method of receiving the test results, such as by mail, email, or through an online portal, and provide the corresponding contact details.
7. Review the completed form thoroughly to ensure all sections are filled out correctly and no vital information is missing.
8. If required, sign and date the form to acknowledge your consent for the requested test.
9. Once the form is completed, submit it to the laboratory or medical facility according to their specified instructions.

Who needs a molecular diagnostics request form?

1. Patients who suspect they may have a specific genetic disorder and need confirmation through molecular testing.
2. Individuals with a family history of certain genetic conditions who want to determine their risk status or explore possible genetic mutations.
3. Clinicians or physicians who need to order molecular diagnostics tests for their patients to aid in diagnosis, treatment planning, or monitoring disease progression.
4. Researchers or scientists involved in molecular biology or genetics studies requiring specialized testing to support their research objectives.
5. Institutions or organizations conducting population-based or large-scale molecular screening programs to identify certain genetic conditions within specific populations.

Note: The specific requirements for who needs a molecular diagnostics request form may vary depending on the laboratory or medical facility, the type of test being requested, and the local regulations and guidelines. It is always recommended to consult with a healthcare professional or the testing laboratory for accurate and up-to-date information.

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