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Clinical Genomics Test Requisition Form
Testing can also be ordered via online portal please scan or click on QR code.
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STEP 1: PATIENT INFORMATIONPatients
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How to fill out clinical genomics test requisition
How to fill out clinical genomics test requisition
01
Obtain the patient's demographics and contact information.
02
Fill out the reason for the test and provide pertinent clinical history.
03
Specify the type of test required (e.g. whole exome sequencing, single gene testing).
04
Include information about the referring healthcare provider and their contact information.
05
Sign and date the requisition form.
Who needs clinical genomics test requisition?
01
Patients who require genetic testing to diagnose or manage a genetic condition.
02
Healthcare providers who are ordering genetic tests for their patients.
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What is clinical genomics test requisition?
A clinical genomics test requisition is a document used to request genetic testing for patients, which includes details about the patient's medical history, the specific tests being requested, and the clinical rationale for the testing.
Who is required to file clinical genomics test requisition?
Healthcare providers, such as physicians and genetic counselors, are required to file clinical genomics test requisitions on behalf of their patients when they deem genetic testing necessary.
How to fill out clinical genomics test requisition?
To fill out a clinical genomics test requisition, the healthcare provider must complete patient demographics, clinical information, the specific tests requested, and sign the form to validate the submission.
What is the purpose of clinical genomics test requisition?
The purpose of a clinical genomics test requisition is to facilitate the process of obtaining genetic tests for diagnosis, treatment planning, and understanding the genetic predisposition of the patient to certain diseases.
What information must be reported on clinical genomics test requisition?
The requisition must include patient demographics, clinical history, the reason for testing, specific tests requested, and the signature of the healthcare provider.
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