How to Order Tests

REQUIRED:

1. Download, fill-in, and print the Test Requisition Form
2. Write in the test name at the bottom of the Test Requisition Form

May be required:

• Complete the Financial Responsibility Form when commercial insurance is to be billed
• Complete the Medicare Advance Beneficiary Notice of Noncoverage (ABN) Form as needed
• Complete the Genetic Testing Consent Form. (This form is required for NY State and can be used by anyone who would want to complete it)

Not required:

• Specimen Collection and Shipping Information is available if needed.

When you have completed all necessary documents, send them along with the specimen to:

DDC Clinic Molecular Diagnostics Laboratory
14567 Madison Rd.
Middlefield, OH 44062