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CONSTITUTIONAL (BLOOD) TEST REQUISITION FORM Phylogenetic Laboratories Indiana University School of Medicine 975 W. Walnut, IB 350, Indianapolis, IN 46202 317/2742243 (Office) 317/2781616 (Fax)Patient

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How to fill out constitutional blood test requisition

01

Ensure the patient's information is correctly filled out including name, date of birth, and any other identifiers

02

Indicate the type of blood test requested and any specific instructions from the healthcare provider

03

Include the date and time of the requisition

04

Verify that all necessary signatures are included on the form

Who needs constitutional blood test requisition?

01

Patients who require a constitutional blood test for health screening purposes

02

Healthcare providers who are ordering blood tests for diagnostic purposes

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What is constitutional blood test requisition?

A constitutional blood test requisition is a formal request or document used to order specific blood tests that assess an individual's genetic or hereditary traits, often for medical, legal, or research purposes.

Who is required to file constitutional blood test requisition?

Typically, healthcare providers, including doctors or genetic counselors, are required to file a constitutional blood test requisition when ordering these tests for their patients.

How to fill out constitutional blood test requisition?

To fill out a constitutional blood test requisition, the requester must provide patient information (such as name and date of birth), select the specific tests required, provide clinical information or reason for testing, and sign the document.

What is the purpose of constitutional blood test requisition?

The purpose of a constitutional blood test requisition is to formally request blood tests that can reveal genetic disorders, assess risk for hereditary conditions, or help in diagnosing medical conditions.

What information must be reported on constitutional blood test requisition?

The requisition must include the patient's personal details, the requested tests, clinical history, healthcare provider's details, and any relevant insurance information.

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