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X G H E R E D I TA R Y C A N C E R R E Q U I S I T I O N F O R M 2 0 2 2. 0 9 .1 5 Phone: 800.739.4137 | Fax: 800.893.0276 | support@tempus.com A. PATIENT INFORMATION (REQUIRED)B. ORDERING PHYSICIAN/GENETIC

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How to fill out xg hereditary cancer requisition

01

Obtain the xG Hereditary Cancer Requisition form from your healthcare provider.

02

Fill out all required personal information accurately, including name, date of birth, and contact information.

03

Provide detailed family history information, including any known cases of cancer and age of onset.

04

Indicate the specific genetic tests requested by your healthcare provider.

05

Sign and date the form to confirm consent for testing.

06

Return the completed form to your healthcare provider or the specified testing laboratory.

Who needs xg hereditary cancer requisition?

01

Individuals with a personal or family history of certain types of cancer may need an xG Hereditary Cancer Requisition form to determine their genetic risk factors.

02

People who are considering genetic testing for hereditary cancer syndromes may also need to fill out this requisition form.

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What is xg hereditary cancer requisition?

The xg hereditary cancer requisition is a form used to collect detailed family and medical history regarding hereditary cancer conditions for individuals undergoing genetic testing.

Who is required to file xg hereditary cancer requisition?

Individuals who are being tested for hereditary cancer risk, often including their healthcare providers or genetic counselors, are required to file the xg hereditary cancer requisition.

How to fill out xg hereditary cancer requisition?

To fill out the xg hereditary cancer requisition, provide accurate personal and family medical history, including any known hereditary cancer syndromes, and follow the detailed instructions provided with the form.

What is the purpose of xg hereditary cancer requisition?

The purpose of the xg hereditary cancer requisition is to gather necessary information to assess an individual's risk of hereditary cancer and to facilitate appropriate genetic testing and counseling.

What information must be reported on xg hereditary cancer requisition?

Required information includes personal demographics, detailed family medical history of cancer, specific types of cancer, age of diagnoses, and any previous genetic testing results.

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