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A test requisition form for genomic diagnostics, primarily for ordering genetic tests including cancer-related tests. The form captures patient and sample information, ordering provider details, and specific testing indications. It includes various testing options, sample requirements, shipping instructions, and billing information.

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How to fill out genomic diagnostics test requisition

01

Obtain the genomic diagnostics test requisition form from the laboratory or healthcare provider.

02

Fill in patient details, including name, date of birth, gender, and contact information.

03

Provide the referring physician's information including name, contact number and address.

04

Specify the type of genomic test being requested, such as whole genome sequencing or targeted gene panels.

05

Indicate the reason for testing, including any relevant family history and clinical signs.

06

Check off any insurance or billing information requirements.

07

Sign and date the form, confirming that all information provided is accurate.

08

Submit the requisition form along with any necessary biological sample, following the lab's submission guidelines.

Who needs genomic diagnostics test requisition?

01

Individuals with a family history of genetic disorders.

02

Patients showing symptoms that may have a genetic basis.

03

Couples planning a pregnancy with known genetic concerns.

04

Patients requiring treatment decisions based on genomic information.

05

Individuals seeking personalized medicine approaches tailored to their genetic makeup.

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What is genomic diagnostics test requisition?

A genomic diagnostics test requisition is a formal request for testing that analyzes a person's genetic material to identify any genetic disorders or predispositions to diseases.

Who is required to file genomic diagnostics test requisition?

Typically, healthcare providers such as doctors or genetic counselors are required to file a genomic diagnostics test requisition on behalf of their patients.

How to fill out genomic diagnostics test requisition?

To fill out a genomic diagnostics test requisition, one must provide patient identification information, specify the tests requested, and include relevant medical history and indication for testing.

What is the purpose of genomic diagnostics test requisition?

The purpose of a genomic diagnostics test requisition is to enable healthcare providers to order genetic tests that can help diagnose hereditary conditions, guide treatment decisions, and assess disease risk.

What information must be reported on genomic diagnostics test requisition?

The requisition must report patient demographics, ordering provider details, clinical information, consent for testing, and specific tests requested.

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