Anatomic (Surgical) Pathology Test Requisition Form - Medical ... 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'Ordering Physician/Laboratory' section. Include the physician’s first and last name, NPI, practice name, complete address, phone number, and fax number.
3. In the 'Specimen Collection Information' section, enter the date collected and select the appropriate site from the options provided (e.g., Biopsy, Cone).
4. Complete the 'Patient Information' section by entering the patient's name, address, date of birth, gender, and SS#. Ensure all required fields are filled out accurately.
5. Fill in the 'Billing Information' section. Indicate whether it is patient billing or insurance billing and provide necessary details such as diagnosis codes and insurance carrier information.
6. Finally, ensure that all sections are reviewed for accuracy before submitting your form through our platform.

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