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Fields Highlighted in Blue are Required3494 Progress Drive, Bensalem, PA 19020 Toll Free pH: (800) 327 2764 Toll Free Fax: (855) 3494 Advanced Molecular Test Request Form SEX:PATIENT NAME:ACCESSION
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How to fill out advanced molecular test requisition

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How to fill out advanced molecular test requisition

01
Step 1: Obtain the advanced molecular test requisition form from the testing facility.
02
Step 2: Fill out the patient's personal information including name, date of birth, and contact information.
03
Step 3: Provide detailed information about the specific test being requested, including test name and reason for ordering.
04
Step 4: Include relevant medical history and any additional information that may be helpful for the testing process.
05
Step 5: Sign and date the requisition form to authorize the test request.
06
Step 6: Submit the completed form to the testing facility and follow any additional instructions provided.

Who needs advanced molecular test requisition?

01
Patients who require advanced molecular testing to diagnose or monitor a medical condition.
02
Healthcare providers who are ordering advanced molecular tests for their patients.
03
Research institutions conducting studies that involve advanced molecular testing.
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Advanced molecular test requisition is a formal request used to order specific molecular tests that analyze genetic material to diagnose, manage, or predict diseases and conditions.
Healthcare providers, such as physicians or specialists who are prescribing molecular tests for their patients, are required to file advanced molecular test requisitions.
To fill out an advanced molecular test requisition, the healthcare provider must include patient information, the specific tests requested, clinical information supporting the need for the tests, and relevant insurance details.
The purpose of the advanced molecular test requisition is to ensure that the molecular tests are medically necessary and to facilitate proper communication between providers and laboratories concerning the tests.
The requisition must report patient demographics, the requested tests, clinical rationale, ordering provider's information, and insurance and billing information.
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