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Requisitions and Forms

The forms contained in this section are subject to change. Up-to-date forms may be downloaded on this site or obtained by calling Client Services at 505-938-8922 in Albuquerque or toll-free at 800-245-3296.

Requisitions

TriCore's CustomPlus requisitions are personalized based on your individual ordering needs. The requisitions list the 40 tests you most commonly request, which means you will spend less time writing in orders. As with previous forms, any tests not included in the custom list may be written in.

To obtain additional copies of your existing TriCore requisition (when no changes are needed), please call TriCore's Help Desk at 505-938-8974 or toll-free at 800-245-3296 Ext. 8974. Call your Sales and Service representative at 505-938-8917 or 800-245-3296 Ext. 8917 to make changes to your existing requisition or to order custom or specialized requisitions.

Download Forms:

Informed Consent for Genetic Analysis

New Mexico law requires that written, informed consent for genetic analysis be obtained from patients after they have received a full explanation of the proposed testing and the significance of possible results. The ordering physician, healthcare provider or genetic counselor is responsible for obtaining and retaining such consent from the patient before the specimen is collected.

To assist in the process, TriCore Reference Laboratories provides a model Informed Consent for Genetic Analysis consent form. Physicians may use this form or other genetic consent forms prepared by their health care organizations. The original consent form should be kept with the patient chart.

TriCore offers the services of a genetic counselor to assist physicians regarding issues of informed consent and result interpretation.

Download Forms: Advance Beneficiary Notice

You should present the ABN form on TriCore’s behalf to Medicare patients whose specimens you collect when there is genuine doubt that Medicare will pay for a laboratory test. If TriCore collects your patient’s specimen at one of our patient care centers, we will present the ABN if appropriate. Prior to collecting the specimen, please ask the patient to sign the form indicating they have been informed that 1) Medicare may not provide coverage for a test or tests, and 2) they may be held responsible for the charges. You should then offer the patient a copy of his or her signed ABN and send the original to TriCore along with the requisition and specimen.

For more information or to download ABN forms, click here.

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