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Click ‘Get Form’ to open the quantiferon gold requisition in the editor.
Begin by filling out the 'Patient Information' section. Clearly print the patient's first name, last name, address, city, state, zip code, date of birth, gender, and race. Ensure that you include a chart number or other ID as this is required.
In the 'Status of Patient' section, indicate whether this is an initial test or a repeated test by selecting 'Yes' or 'No'. Provide details regarding previous positive PPD tests and any live vaccines received in the last 30 days.
Complete the 'Specimen Information' section by entering the date and time collected along with the collector's initials. Record incubation times accurately to ensure proper processing.
Finally, fill out the 'Submitter/Requester Information' with site number, provider details, and contact information. Don’t forget to sign and date the form before submission.

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