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Patient Information
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DIAGNOSIS CODE(S); The ICD-10 codes provided are based on AMA guidelines and are for information purposes only. ICD-10 coding is the sole responsibility of the ordering provider
General







General Screening





Increased Risk






Abnormal Findings







Family History
DIAGNOSIS CODE(S) |TYPE-IN
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ICD-10 codes ICD-10 code description Action

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Testing Option

PHYSICIAN SIGNATURE:

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When ordering the tests, The physician is required to make independent medical decisions with regards to each test ordered. Only tests that are medically necessary will be reimbursed by the government or the private health plan. Read more

PATIENT/LEGAL REPRESENTATIVE SIGNATURE:

For non-touch screen devices, the patient/legal representative needs to type their full name below and provide a secondary identifier.

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PATIENT
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DIAGNOSTIC CODES
Medical Necessity
NIPT Test Order
 
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