Get the free Cologuard® Order Requisition Form

This document serves as a guide for discussing Cologuard and colon cancer screening with healthcare providers. It includes questions to prepare for the conversation, information about the Cologuard

How to fill out cologuard order requisition form

How to fill out cologuard order requisition form

1. Obtain the Cologuard order requisition form from a healthcare provider or the Cologuard website.
2. Fill in the patient's personal information, including name, date of birth, and insurance information if applicable.
3. Indicate the reason for the test and any relevant medical history required by the form.
4. Provide the physician's information, including name, contact information, and National Provider Identifier (NPI) number.
5. Check any necessary consent boxes regarding privacy and data use according to HIPAA regulations.
6. Review the form for any errors or incomplete sections.
7. Sign and date the form where required.
8. Submit the completed form to the designated Cologuard address or online submission site as instructed.

Who needs cologuard order requisition form?

1. Individuals aged 45 and older or those at increased risk for colorectal cancer who require screening.
2. Patients who have discussed with their healthcare provider about alternatives to traditional colonoscopies.
3. Those looking for a non-invasive testing option for colorectal cancer screening.

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What is cologuard order requisition form?

The Cologuard order requisition form is a document used by healthcare providers to request the Cologuard test, a non-invasive screening test for colorectal cancer that analyzes DNA and blood in a stool sample.

Who is required to file Cologuard order requisition form?

Healthcare providers, such as physicians or nurse practitioners, are required to file the Cologuard order requisition form when they recommend the Cologuard test for patients who meet specific criteria for colorectal cancer screening.

How to fill out cologuard order requisition form?

To fill out the Cologuard order requisition form, providers must complete patient information, indicate the medical necessity for the test, sign the form, and provide any additional relevant information as required.

What is the purpose of cologuard order requisition form?

The purpose of the Cologuard order requisition form is to formally request the Cologuard test while ensuring that all necessary patient information and medical justifications are documented for insurance and testing purposes.

What information must be reported on cologuard order requisition form?

The Cologuard order requisition form must report the patient's name, date of birth, insurance information, relevant medical history, details supporting the need for screening, and the healthcare provider's information.