Clinical Genomics Test Requisition Form - Page 1 of 5 2025

1. Click ‘Get Form’ to open the Clinical Genomics Test Requisition Form in our platform.
2. Begin by filling out the 'Patient Information' section. Enter the patient's name, address, date of birth, and contact details. Ensure all fields are completed to avoid delays.
3. In the 'Specimen Information' section, select the type of specimen you are submitting (e.g., Blood or Saliva) and provide any relevant medical history that may affect specimen acceptance.
4. Complete the 'Ordering Physician/Sending Facility' section with accurate details about the facility and provider. This ensures that all parties receive necessary reports.
5. Review the 'Confirmation of Informed Consent' section carefully. The medical professional must sign and date this area to confirm consent for testing.
6. Finally, check the 'Insurance Billing' section to include necessary insurance information and ensure proper billing procedures are followed.

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