cologuard order form

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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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FOCUSING INFORMATION AFFECTED: The following are the medical conditions that are being focused on in this specific order: Attention Deficit Hyperactivity Disorder (ADHD) Attention Deficit Hyperactivity Disorder (ADHD) Seizures Tourette's Syndrome Attention Deficit Disordered (formerly known as ADD/ADHD) Tourette's Syndrome Dementia Alzheimer's Disease Alzheimer's Disease Cerebral Palsy Required information from the patient. ADDITIONAL INFORMATION: Patients must have a current medical history, including; diabetes, kidney disease, chronic lung conditions, hypertension, heart disease, recent history of stroke, brain tumors, and pregnancy. Patients must be willing to sign written information regarding risk factors regarding their family history of heart disease, stroke, brain tumor, and blood clots. Patients must be willing to provide additional information about their psychiatric history, and any current medication use. For additional information regarding this patient group, please click on ADDITIONAL INFORMATION. Required information from applicant. INSTRUCTIONS: Patient will be guided through the ordering process and provided with a form which must be completed by a physician. A list of the prescription medications to be ordered will be provided. The order will require you to submit the information listed on the form, which includes identifying information, such as the patient's name and social security number. In return, a prescription will be issued for the medications stated on the form.

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Hey guys so question was asks how do you make an order form or for your customers or for you to order inventory that's going to tell you when you've gone over your price, so we're going to make a template that you can use I'm just going to use a bunch of generic stuff you can modify it, but it's going to teach you the basics, and then you can go from there you can make this as complex or as simple as you want as you see very basic set up already I always find it helpful that when I'm trying to make a template use some fake numbers then I can delete them save it with it empty and then every time I have like a new project, or I want to use that template I'll make a copy of it rename it that way you don't have to make this setup every single time generic numbers I'm going to put in a bunch of stuff that way it's easier to see the format here we're going to put in our limit we're going to say it's $40 our tax rate is going to be 6% and some of these things I've already formatted to be dollar just hit the dollar sign for this one I just hit the % and had it show two decimal places depending on where you live we're also going to all of these make them into dollars these we don't really care these can just stay up at the top you see that they're just general it's perfectly fine then we also want this comp to equal your boxes times cost per box, and then we want it to do that all the way through for subtotal we want it to equal the sum all of these boxes and hit enter the tax rate we want it to equal the subtotal times the tax rate and last but not least the grand total is going to equal some at least two and see that last one to start an equation you can either use plus or equals it works the same I want to format something, so it looks a little better we'll make all these things in the center same with those all right, but it's still not warning us obviously we're over our costs, so we need to use some if-then statements to make it warn us and make everything work so in this total I'm going to do equals if that's what I want, so that wants the logic test, so I'm going to say if this cell is less than I sixteen Plus all right so what I've pretty much done is said if is our limit is less than the subtotal plus the tax then I want it to just have the so total tax and display that if what I wanted to do I wanted to display over limit by will see that didn't fricking work so get a reverse our sign all right, so we're over our limit and this will tell us we can even put in something to tell them by how much, so this can just equal if this cell equals over limit Hey I want you to do 16 + 17 J — otherwise zero it's formatted as a dollar so here what it's saying is if the other cell equals over limit by its going to do the calculation for us, it's going to add subtotal and tax and then subtract our limit to tell us how much we're over by and so then the person could go in maybe they zero out a couple of things until they are good to order there we have it prep...


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