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CYTOLOGY GYNECOLOGIC
TEST REQUISITION2119 E. 93rd / L15
Cleveland, OH 44106
216.444.5755 or 800.628.6816FORM_CLIENT INFORMATIONPATIENT INFORMATION (PLEASE PRINT IN BLACK INK)
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Last Name
First
MI
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Address
Birth
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How to fill out cytology pap test requisition
How to fill out cytology pap test requisition
01
Fill out patient information including name, date of birth, and medical record number.
02
Specify the type of test being requested (e.g. Pap smear, HPV testing).
03
Indicate the reason for the test (e.g. routine screening, follow-up of abnormal results).
04
Provide any relevant medical history or previous test results.
05
Sign and date the requisition form.
Who needs cytology pap test requisition?
01
Individuals who are scheduled for a cervical cancer screening.
02
Patients who have abnormal Pap test results and need follow-up testing.
03
Healthcare providers requesting cervical cytology testing for their patients.
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What is cytology pap test requisition?
Cytology pap test requisition is a form used to request a cytology pap test, which is a screening test for cervical cancer.
Who is required to file cytology pap test requisition?
Healthcare providers or physicians are required to file cytology pap test requisition on behalf of their patients.
How to fill out cytology pap test requisition?
Cytology pap test requisition can be filled out by providing patient information, clinical history, and reason for test request.
What is the purpose of cytology pap test requisition?
The purpose of cytology pap test requisition is to screen for cervical cancer or detect abnormal changes in the cervix.
What information must be reported on cytology pap test requisition?
The information reported on cytology pap test requisition includes patient's name, date of birth, medical history, and reason for test.
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