Get the free Exome Requisition Form - UChicago Genetic Testing
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Clinical Genomics Test Requisition Form Page 1 of 5 (Some Sequencing and Microarray)COMPLETE ENTIRE FORM AND SUBMIT PEDIGREE/CLINIC NOTES TO AVOID Delays submit an order via email, please send the
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How to fill out exome requisition form
How to fill out exome requisition form
01
Step 1: Start by entering the patient's personal information such as name, date of birth, and contact details.
02
Step 2: Provide relevant medical history of the patient including past diagnoses and current symptoms.
03
Step 3: Indicate the reason for ordering exome sequencing and specify any known genetic conditions in the patient or family.
04
Step 4: Include information about the healthcare provider ordering the test and how results should be communicated.
05
Step 5: Complete the form with any additional instructions or special considerations.
Who needs exome requisition form?
01
Individuals suspected of having a genetic disorder or hereditary condition.
02
Patients with a family history of genetic diseases or chromosomal abnormalities.
03
People undergoing preconception or prenatal testing for genetic screening purposes.
04
Healthcare providers requesting genetic testing to aid in diagnosis and treatment decisions.
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