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Grand River Regional Cancer Center Cancer Genetics Referral Form Please fax this form to 5197492025. If you have questions or concerns, please call 5197494300, ext. 2832. A FAMILY HISTORY QUESTIONNAIRE

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How to fill out genetics-referral-form-fhq-combined

01

Fill in the patient's personal information such as name, date of birth, and contact details.

02

Provide detailed medical history information including any genetic conditions present in the family.

03

Specify the reason for referral and any specific tests that are being requested.

04

Include any relevant test results or documentation that may assist in the evaluation process.

05

Ensure the form is signed by the referring healthcare provider.

Who needs genetics-referral-form-fhq-combined?

01

Individuals who suspect they may have a genetic condition.

02

Healthcare providers looking to refer a patient for genetic testing or counseling.

03

Families with a history of genetic disorders seeking specialized medical evaluation.

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What is genetics-referral-form-fhq-combined?

Genetics-referral-form-fhq-combined is a form used to refer individuals to a genetics clinic for evaluation and testing.

Who is required to file genetics-referral-form-fhq-combined?

Healthcare providers, genetic counselors, and other medical professionals are required to file genetics-referral-form-fhq-combined.

How to fill out genetics-referral-form-fhq-combined?

Genetics-referral-form-fhq-combined can be filled out online or manually by providing patient information, medical history, and reason for referral.

What is the purpose of genetics-referral-form-fhq-combined?

The purpose of genetics-referral-form-fhq-combined is to streamline the process of referring individuals for genetic evaluation and testing.

What information must be reported on genetics-referral-form-fhq-combined?

Genetics-referral-form-fhq-combined must include patient demographics, family history of genetic conditions, medical history, and reason for referral.

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