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Instructions for requestor: Return this completed request, IRB protocol/summary/exemption, and letter of intent to biomaterials@versiti.org. Requestor Information Requestor Organization Requestor
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How to fill out new hematology genetics requisition

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How to fill out new hematology genetics requisition

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Step 1: Obtain a new hematology genetics requisition form from your healthcare provider.
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Step 2: Fill out your personal information accurately, including your name, date of birth, and contact information.
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Step 3: Provide your insurance details, including your insurance provider and policy number.
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Step 4: Specify the reason for the hematology genetics test and provide any relevant medical history or symptoms.
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Step 5: Indicate the type of sample to be collected for testing, such as blood or bone marrow.
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Step 6: Sign and date the requisition form.
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Step 7: Submit the completed form to the designated laboratory or healthcare facility for processing.

Who needs new hematology genetics requisition?

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Individuals who require specialized testing related to hematology genetics may need to fill out a new hematology genetics requisition form. This can include patients with suspected inherited blood disorders, individuals undergoing genetic counseling, or individuals participating in research studies related to hematology genetics.

What is New Hematology Genetics Requisition Form?

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The new hematology genetics requisition is a standardized form used to request genetic testing and analysis related to hematological conditions.
Healthcare providers, including physicians and genetic counselors, who are assessing patients for potential hematological genetic disorders are required to file the requisition.
To fill out the requisition, provide patient identification details, clinical information, specific tests requested, and any relevant family history or medical records.
The purpose is to collect necessary information to facilitate genetic testing that aids in diagnosing, managing, and understanding hematological disorders.
Information reported must include patient demographics, clinical indications for testing, specific tests requested, and family and medical history relevant to the condition.
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