Children s Hospital Los Angeles - chla 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Patient/Donor Information' section. Indicate whether you are entering details for a donor or patient, and complete all required fields marked in red, including last name, first name, date of birth, gender, and race.
3. Next, provide the 'Clinical Information' such as clinical diagnosis and ICD-9 code. Ensure that you include the patient's address and contact information accurately.
4. In the 'Billing Information' section, enter details about the referring institution and any necessary account numbers. Make sure to check if duplicate reports need to be sent to another physician.
5. Complete the 'Specimen Collection Information' by noting the date and time collected. Ensure that all specimen requirements are met as outlined in the document.
6. Finally, review all entries for accuracy before submitting your form through our platform. This ensures a smooth processing experience.

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