Exact Sciences Laboratories Cologuard Order Requisition Form 2016 free printable template
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COLOGUARD ORDER REQUISITION FORM EXACT SCIENCES LABORATORIES LLC 145 E. Badger Rd Ste 100 Madison WI 53713 P 844. 870. 8879 www. exactlabs. com Fax completed form to 844. 870. 8875 REQUIRED Provider Information PROVIDER INFORMATION Healthcare Organization Location Address Provider Name City State Zip NPI Phone Number or DEA if NPI is not available Fax Number To receive results for this order please provide a secure FAX number PATIENT INFORMATION Patient ID/MRN First Name Last Name DOB...
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How to fill out Exact Sciences Laboratories Cologuard Order Requisition
How to fill out Exact Sciences Laboratories Cologuard Order Requisition Form
01
Download the Exact Sciences Laboratories Cologuard Order Requisition Form from the official website.
02
Complete the patient's information section, including name, date of birth, and contact information.
03
Provide the physician's details, including name, contact number, and address.
04
Fill in the patient's insurance information, if applicable.
05
Indicate the reason for ordering the Cologuard test in the specified section.
06
Check the appropriate boxes regarding any relevant medical history or symptoms.
07
Sign and date the form, ensuring all information is accurate.
08
Submit the form along with the patient's sample as per the provided instructions.
Who needs Exact Sciences Laboratories Cologuard Order Requisition Form?
01
Individuals aged 45 and older who are at average risk for colorectal cancer.
02
Patients with a family history of colorectal cancer.
03
Healthcare providers who are recommending colorectal cancer screening.
04
Patients experiencing gastrointestinal symptoms that warrant screening.
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People Also Ask about
Do you need an order for cologuard?
A Cologuard test requires a prescription from your doctor.
Can I order cologuard myself?
Cologuard is only available with a prescription. Your primary care provider can order the test, and you can also work with a telemedicine provider who can help prescribe the test if you meet the criteria for colorectal cancer screening.
How do I order cologuard for my patient?
For more information about the ordering options, call 1-844-870-8870. Cologuard is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool.
How to get a free cologuard kit?
Call 1-888-345-0225 or fill out the form below to learn about free colon cancer screening and find out if you're eligible to have a free FIT kit (at-home stool test) mailed to you.
Can a patient order cologuard?
Only orders from licensed healthcare providers are accepted.
How does my doctor order cologuard?
Your doctor will need to prescribe the test for you before you're able to order a Cologuard kit. You can fill out a form on the company's website that makes a customized order form for you to bring to your doctor.
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What is Exact Sciences Laboratories Cologuard Order Requisition Form?
The Exact Sciences Laboratories Cologuard Order Requisition Form is a document used by healthcare providers to order the Cologuard test, which is a non-invasive stool DNA test for colorectal cancer screening.
Who is required to file Exact Sciences Laboratories Cologuard Order Requisition Form?
Healthcare providers, such as doctors or nurse practitioners, are required to file the Exact Sciences Laboratories Cologuard Order Requisition Form when they determine a patient is eligible for the Cologuard test.
How to fill out Exact Sciences Laboratories Cologuard Order Requisition Form?
To fill out the Cologuard Order Requisition Form, a healthcare provider must complete sections including patient information, clinical information, order details, and sign the form before submitting it to Exact Sciences Laboratories.
What is the purpose of Exact Sciences Laboratories Cologuard Order Requisition Form?
The purpose of the Exact Sciences Laboratories Cologuard Order Requisition Form is to facilitate the ordering of the Cologuard test and to ensure the necessary patient information is provided for accurate processing and reporting of test results.
What information must be reported on Exact Sciences Laboratories Cologuard Order Requisition Form?
The Exact Sciences Laboratories Cologuard Order Requisition Form must report information such as patient demographics, clinical history, provider information, test indication, and any relevant medical history that supports the need for screening.
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