CIRL Test Requisition Form - Medical College of Wisconsin 2025

1. Click ‘Get Form’ to open the CIRL Test Requisition Form in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's first name, middle initial, date of birth, social security number, street address, city/state/zip code, and phone number.
3. Indicate the patient's race and ethnicity by selecting the appropriate options provided in the form.
4. In the 'Specimen Type' section, check the appropriate specimen type and provide any additional requested information such as date collected and specimen ID.
5. Next, move to the 'Test(s) Requested' section. Check all applicable tests that are being requested for the patient.
6. Complete the 'Patient History/Clinical Info' section by providing clinical diagnosis and relevant dates.
7. Fill in your facility's information including name, physician details, address, phone, and fax numbers to ensure results are returned correctly.
8. Finally, review all entered information for accuracy before submitting your form through our platform.

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