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Hereditary Cancer Requisition 1351 Barclay Blvd., Buffalo Grove, IL 60089 Tel: 855.467.2849 Fax: 224.588.9941 www.gopathlabs.comPATIENT INFORMATION (Please print)ORDERING PHYSICIAN / LAB INFORMATION
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How to fill out hereditary cancer requisition

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How to fill out hereditary cancer requisition

01
Obtain the hereditary cancer requisition form from the healthcare provider or laboratory.
02
Fill out the patient's demographic information, such as name, date of birth, and contact information.
03
Provide detailed family history information, including any known cases of cancer, age of onset, and relationship to the patient.
04
Indicate the type of genetic testing requested and reason for testing, such as personal or family history of cancer.
05
Include any relevant medical records or test results that may assist in the evaluation of hereditary cancer risk.
06
Sign and date the requisition form before submitting it to the laboratory for processing.

Who needs hereditary cancer requisition?

01
Individuals with a personal or family history of cancer may need a hereditary cancer requisition to determine their risk of carrying a genetic mutation predisposing them to cancer.
02
Healthcare providers, genetic counselors, or researchers involved in cancer risk assessment and genetic testing may also require a hereditary cancer requisition to facilitate testing and interpretation of results.
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Hereditary cancer requisition is a form or document used to request genetic testing for cancer predisposition genes.
Healthcare providers or genetic counselors are usually required to file hereditary cancer requisition on behalf of patients.
To fill out hereditary cancer requisition, healthcare providers typically need to input patient information, family history of cancer, and reason for genetic testing.
The purpose of hereditary cancer requisition is to identify individuals who may have an increased risk of developing hereditary cancers, allowing for personalized cancer screening and management plans.
Information such as patient demographics, family history of cancer, previous cancer diagnoses, and reasons for genetic testing must be reported on hereditary cancer requisition.
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