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MILFORD MOLECULAR DIAGNOSTICS LABORATORY, LLC 2044 Bridgeport Avenue, Milford, CT 06460 (203) 8781438 Fax (203) 8780109 http://www.dnalymetest.com/CT LIC# CL0699CLIA# 07D2067401Routine Partial N Gene

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How to fill out request for lyme disease

01

Obtain the required request form for Lyme disease from your healthcare provider.

02

Fill in your personal information accurately including full name, date of birth, address, and contact information.

03

Provide a detailed description of your symptoms, potential exposure to ticks, and any previous diagnoses related to Lyme disease.

04

Attach any supporting documents such as medical records, test results, or tick bite history.

05

Submit the completed request form to your healthcare provider or the appropriate testing facility as instructed.

Who needs request for lyme disease?

01

Individuals who suspect they may have been exposed to ticks carrying Lyme disease

02

Individuals experiencing symptoms consistent with Lyme disease

03

Individuals seeking a definitive diagnosis for Lyme disease

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What is request for lyme disease?

Request for lyme disease is a form or document used to request information, testing, or treatment related to lyme disease from a healthcare provider or public health agency.

Who is required to file request for lyme disease?

Anyone who suspects they may have lyme disease or has been exposed to ticks and is showing symptoms of the disease may be required to file a request for lyme disease.

How to fill out request for lyme disease?

To fill out a request for lyme disease, one typically needs to provide personal information, medical history, symptoms, and any relevant exposure to ticks.

What is the purpose of request for lyme disease?

The purpose of a request for lyme disease is to gather information for diagnosis, testing, and treatment of lyme disease.

What information must be reported on request for lyme disease?

Information such as personal details, medical history, symptoms, recent travel or outdoor activities, and any known exposure to ticks must be reported on a request for lyme disease.

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