Requisitions & Forms

Requisition Forms

CytoGenX has designed a test requisition form to both promote both medically appropriate test ordering and to capture the information required by federal or private health care programs.

Completion of the client, patient and billing information sections are required, as well as the clinical information sections (ICD-9).  This information is necessary for accurate specimen processing, diagnosis coding and billing.

Informed Consent

It is mandatory for the ordering physician to obtain informed consent from the patient for all testing.  The ordering physician must sign the requisition form to attest that he/she has obtained informed consent from the patient.

Ordering Policies

All testing performed at CytoGenX must be requested by an “authorized person” (a person authorized under state law to order testing or receive test results or both).

Changing/Supplementing Orders

After a specimen has been received at CytoGenX, the ordering physician may request additional testing on the specimen or cancel tests already ordered.  These requests are accepted by telephone.  CytoGenX  will document the conversation in a written record and may also send a request for written confirmation to the ordering physician.

Genetic Test Requisition Form   Download
Oncology Test Requisition Form   Download
Supply Requisition   Download
Microarray Consent Download

Why Choose CytoGenx