ORDERING A PHARMACOGENTIC TEST
If you are a patient please contact us to find a physician near you.
PHYSICIANS AND MEDICAL STAFF
You will receive the following items in your PGxOne Kit: 1. 2 Buccal Swabs, 2. Requisition Form, 3. FedEx Envelope and Label.
Take each Buccal Swab and rub the inside of the cheek for a good 30 - 40 seconds. This makes sure that sufficient DNA will be on the Buccal Swab for testing. If there is insufficient DNA a re-swab will be requested. Once the Buccal Swab has been taken, place it back in the container and attach a barcode found at the bottom of the Requisition Form on each container. (There will be extra barcode stickers).
How to Complete an Order and fill out Requisition Form:
Fill out patient information. Insure that it is complete and legible, not leaving anything blank.
Fill out clinic information and ordering physician. This can be filled out or done with a stamp.
Patient insurance information. This can be filled out or a copy of the insurance card or demographic sheet can be included.
Please include a copy of the patient's med list. This includes all current as well as potential medications. This can be printed then potential meds written in.
Select the appropriate Diagnosis Codes. Ask your rep for suggestions if you are not sure.
The physician must sign the front of the requisition form.
Include a print out of the physician notes. (Required by insurance)
Turn the form over and make sure BOTH THE PHYSICIAN AND PATIENT SIGN THE BACK.
Once that is complete; place the Buccal swabs, Requisition Form, Insurance Info, Physician Notes and Med List in the FedEx envelope and attach a label.
Call FedEx for pickup.