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Cologuard order form 2026
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- Click ‘Get Form’ to open the Cologuard order form in the editor.
- Begin by filling out the 'Provider Information' section. Enter your healthcare organization, location address, provider name, city, state, zip code, NPI number (or DEA number if NPI is unavailable), and phone and fax numbers.
- Next, complete the 'Patient Information' section. Input the patient ID/MRN, first and last name, date of birth, sex, and a contact phone number for follow-up. You may also attach a patient demographic sheet if available.
- In the 'Test Information' section, confirm that the test name is Cologuard and provide any necessary ICD-9 codes as applicable.
- Sign and date the certification statement to acknowledge your authority to order Cologuard and maintain HIPAA compliance.
- Fill out the 'Patient Address' section with shipping and billing addresses. If they are the same, check the appropriate box.
- Complete the 'Patient Insurance/Billing Information' section by providing policyholder details and insurance information. Attach a copy of the insurance card if required.
- Finally, ensure that both you and the patient sign where indicated before submitting via fax to complete your order.
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