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- Click ‘Get Form’ to open the Personalized Diagnostics Test Request Form in our editor.
- Begin by filling out the 'Patient Information' section. Enter the patient's name, date of birth, medical record number, and gender. Ensure all fields are completed accurately.
- In the 'Sample Information' section, provide details such as WBC count and % Blasts. This information is crucial for accurate diagnostics.
- Next, complete the 'Reporting Information' section. Include the physician's name, tumor percentage, date and time of collection, and tissue source. Select from options like HUP or PPMC.
- For 'Sample Type', check the appropriate box based on the specimen being submitted (e.g., Bone Marrow in EDTA).
- Finally, fill out the 'Indication for Study' and 'Testing' sections with relevant diagnosis and ICD9 codes to ensure proper analysis.
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