Privacy & Notices

Notice of Privacy Practices

EFFECTIVE DATE

This Notice of Privacy Practices (“Notice”) is effective August 18, 2014. This Notice has been reviewed and revised accordingly on December 20, 2021.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

CONTACT PERSON

Precision Diagnostics, LLC’s Chief Compliance Officer is the contact person for all issues and complaints regarding your health information and privacy rights. If you have any questions or concerns about this Notice, please contact the Chief Compliance Officer at:

U.S. Mail and Overnight Delivery:

Precision Diagnostics ATTN: Darrell Taylor

4215 Sorrento Valley Blvd San Diego, CA 92121

Toll-Free Number:

800-635-6901 ext. 510

WHO WILL FOLLOW THIS NOTICE

This Notice describes the privacy practices described in health information privacy practices followed by the members Precision’s workforce.

YOUR HEALTH INFORMATION

This Notice applies to the information and records Precision has about your Precision laboratory results, and other health information about you that you may have received from Precision. For purposes of this Notice, Your health information may include information received or created by Precision, may be in the form of written or electronic records or spoken words, and may include information about your health history, test results, related billing activity, and any similar types of health-related information about you.

We are required by law to give you this Notice. This Notice provides a summary of the ways we may use and disclose health information about you, and describes your rights and our obligations regarding the use and disclosure of that information. As used in this Notice, “you” and “your” refer to the individual receiving services provided by Precision.

For simplicity, we will refer to all of this information throughout this Notice as “Your Health Information.”

USES AND DISCLOSURES OF HEALTH INFORMATION

The following is a summary of the purposes for which Precision may use and disclose Your Health Information. Not every type of use or disclosure is listed, but the general ways in which Precision uses and discloses Your Health Information will fall under these purposes.

 

Uses and Disclosure for Treatment, Payment, and Health Care Operation.

We may use and disclose Your Health Information for the following purposes:

Treatment: We may use and disclose Your Health Information to provide you with care and with others involved in your care, including doctors, therapists, and other health care professionals.

For example: We are required by law to provide your Precision lab results to the healthcare practitioner that ordered the testing for you. We may need to give your other treating healthcare professionals your Precision lab results so he/she can interpret and properly diagnosis and treat your medical condition.

Payment: We may use and disclose Your Health Information so that the lab testing services you receive at Precision can be billed to you and payment collected from you, your insurance company, or other third party responsible to pay for your care.

For example: We may need to give to your health plan Your Health Information about lab testing services you received from Precision so your health plan will pay us or reimburse you for those services. We may also tell your health plan about specific lab testing that your treating healthcare practitioner has ordered for you to obtain approval, or to determine whether your plan will pay for the testing.

Health Care Operations: We may use and disclose Your Health Information for our own operations and quality assurance processes.

For example: We may use Your Health Information to evaluate internally the performance of our laboratory services. We may use Your Health Information to improve our efficiency and quality of care.

 

Uses and Disclosures of Your Health Information Without Your Authorization.

We may use and disclose Your Health Information without an authorization as may be required or permitted by law. We have to meet many conditions in the law before we may use or disclose health information for these following purposes, however:

To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when we believe disclosure is necessary to prevent or lessen a serious and imminent threat to someone’s health and safety.

Required by Law: We will disclose health information about you when required to do so by federal, state, or local law.

Research: Under very limited circumstances and your specific consent as required by law, we may use and disclose health information about you for medical research. In most cases, we will ask for your permission.

Special Government Functions: We may be required to use or disclose Your Health Information for special government functions, such as military and veterans, national security, protective services for the President, and law enforcement.

Worker’s Compensation: We may disclose Your Health Information for worker’s compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Activities: We may be required to use and disclose Your Health Information for certain public health activities, such as to prevent or control disease, injury, or disability; report disease, injury, and vital events (such as birth or death); assist with the public health surveillance, investigations, and interventions; report adverse events and product defects; help with product recalls; and notify a person who may be at risk of getting or spreading a disease.

Health Oversight Activities: We may disclose Your Health Information to a health oversight agency for activities authorized or required by law, such as audits, investigations, or licensure or disciplinary actions.

Lawsuits and Disputes: We may disclose Your Health Information for lawsuits and legal actions, such as in response to court or administrative orders, subpoenas, discovery requests, and other lawful processes.

Law Enforcement: We may disclose Your Health Information to a law enforcement official for certain law enforcement purposes including: as required by law; for reporting of certain types of injuries; as required by a court order, subpoena, warrant, summons, or similar process; and, in limited situations, about a person who is a victim of a crime.

Coroners, Medical Examiners, and Funeral Directors: We may disclose Your Health Information to coroners or medical examiners for purposes of identifying a deceased person, determining cause of death, or their other duties. We may disclose Your Health Information about you to funeral directors, as permitted by law, as necessary for them to carry out their duties.

Information Not Personally Identifiable and Limited Data Sets: We may use and disclose Your Health Information about you in a way that does not personally identify you by removing certain identifiers (such as name and address) making it unlikely that you could be identified. We also may disclose limited health information, contained in a “limited data set,” as allowed by law.

To Report Abuse, Neglect, or Domestic Violence: We may notify government authorities if we believe someone is the victim of abuse, neglect, or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the individual agrees to the disclosure.

To Business Associates: We may disclose Your Health Information with our contractors who create, receive, maintain, or transmit health information for certain activities on behalf of Precision. All these business associates must agree to safeguard Your Health Information.

Incidental  Disclosures:    Incidental disclosures of Your Health Information may occur as a by-product of permitted uses and disclosures.

Determination of Compliance: We may disclose Your Health Information with the Secretary of the Department of Health and Human Services for purpose of determining Precision’s compliance with any of the HIPAA rules.

Personal Representatives: Minors and incapacitated adults may have “personal representatives.” These personal representatives may be able to act on the individual’s behalf and exercise the individual’s privacy rights.

Fundraising: Precision may not use or disclose PHI for fundraising purposes without valid authorization, unless the information disclosed is limited to general information and is only shared with a Business Associate or institutionally related foundation for the purpose of raising funds for Precision’s benefit, in which case, Precision Diagnostics may contact the individual.

 

Uses and Disclosures of Health Information If You Do Not Object.

Unless you object in writing, Precision may use and disclose health information about you in the following situations:

Individuals Involved in Your Care:

We may disclose, to a family member, friend, or other person you designate, who is involved in your health care or the payment for your health care, Your Health Information that is directly relevant to that person’s involvement.

Notification Purposes:

We may use and disclose Your Health Information directly, or to an entity assisting in a disaster relief effort, so that your family, your personal representative, or another person responsible for your care can be notified about your condition.

 

OTHER USES AND DISCLOSURES OF HEALTH INFORMATION

We will not disclose Your Health Information for any purpose other than those identified in the previous sections without your specific written authorization. We generally will not sell Your Health Information about you or use or disclose health information for marketing. If you give us authorization to use or disclose Your Health Information, you generally may revoke that authorization, in writing, at any time. If you revoke the authorization, we will no longer use or disclose Your Health Information for the reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission. We are required to retain our records of the care that we provided to you.

In some instances, we may need specific written authorization from you in order to disclose certain types of specifically protected information about you, such as information related to mental health, AIDS/HIV, substance abuse, and genetic testing.

 

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding Your Health Information maintained by Precision. To exercise any of these rights, please contact our Chief Compliance Officer.

Right to Inspect and Copy: You have the right to inspect and get a paper or electronic copy of certain of Your Health Information that we keep and use to make decisions about your care. You must submit your request in writing. We may charge a reasonable cost-based fee for copying, mailing, or associated supplies.

We may deny your request to inspect or obtain copies of Your Health Information in certain limited circumstances. If you are denied copies of or access to health information that we keep about you, you may ask that our denial be reviewed. If the law gives you a right to have our denial reviewed, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.

Right to Amend: If you believe Your Health Information maintained by Precision is incorrect or incomplete, you may ask us to amend that information. You have the right to request an amendment as long as the health information is kept by us. You must submit your request in writing and provide a reason to support the request.

We may deny your request if you ask us to amend information that:

• We did not create, unless the person or entity that created the information is no longer available to make the amendment.
• Is not part of the health information that we keep.
• You would not be permitted to inspect and copy.
• Is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures Your Health Information. This is a list of the disclosures that we make of Your Health Information for purposes other than treatment, payment, health care operations, and a limited number of special circumstances involving national security, correctional institutions, and law enforcement. The list also will exclude any disclosures we have made based on your written authorization. Your request should state a time period, not longer than six (6) years.  Your request should indicate in what form you want the list (for example, on paper, electronically, etc.). The first list you request within a 12-month period will be free. For additional lists, we may charge you a reasonable cost-based fee for preparing and providing that list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions: You have the right to request a restriction or limitation on any of Your Health Information that we use or disclose about your treatment, payment, or health care operations. You have the right to request a limit on Your Health Information that we disclose about you to someone who is involved in your care or the payment for your health care, such as a family member or friend.

Except as required by law, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or we are required by law to disclose the information. Upon receipt of your written request, we will agree not to disclose to a health plan information about services for which you pay out-of-pocket in full, subject to certain exceptions.

Right to Confidential Communication: You have the right to request that we communicate with you about medical matters a certain way or at a certain location. For example, you may ask that we only contact you at work or by mail. We will not ask you the reason for your request. We will try to accommodate all reasonable requests. Your request must be in writing and specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice: You have the right to a paper copy of this Notice.  You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice and to make the revised Notice effective for health information we have about you as well as any health information we create or receive in the future. We will post the current Notice on our website and at our laboratory offices with its effective date in the top right hand corner.

COMPLAINTS

• If you believe your privacy rights have been violated, you may file a complaint with our Chief Compliance Officer or with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• You will not be penalized or retaliated against by Precision for filing a complaint.

PRECISION’S DUTIES

• We are required by law to: maintain the privacy of health information, provide to you this Notice of our duties and privacy practices with respect to Your Health Information, follow this Notice as may be amended from time to ti We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

_______________________________________________________________________

Non-Discrimination Policy and Access Procedure

A. Policy:

As a recipient of federal reimbursement for its laboratory testing services, Precision Diagnostics does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, or national origin, or on the basis of disability or age from access to, or receipt of, Precision Diagnostics laboratory testing services and the benefits thereof, whether the testing services are carried out by Precision Diagnostics directly or through a contractor or any other entity with whom Precision Diagnostics arranges to carry out those services. Likewise, Precision Diagnostics does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, or national origin, or on the basis of disability or age, from opportunities for employment by Precision Diagnostics.

• This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Part 80, 84, and 91.

B. Access Notice:

As a clinical reference laboratory located and operating in San Diego, California, Precision Diagnostics provides laboratory testing on patient samples generally shipped via air carriers as well as local couriers from the unaffiliated offices of its health care practitioner customers. Precision Diagnostics therefore has very limited in-person interaction with patients for whom it performs its laboratory testing services. However, for patients and clients and others throughout the United States who may from their respective locations seek access to, or receipt of, Precision Diagnostics laboratory testing services and the benefits thereof, or otherwise to access or communicate with Precision Diagnostics, Precision Diagnostics also strives to make such communications accessible to and usable by disabled persons, including persons with impaired hearing and vision, through assistive and communication aids provided without additional charge (as described in Sections C and D). In addition, Precision Diagnostics has implemented access features at its San Diego clinical reference laboratory facility, as set forth below. Precision Diagnostics also has posted an Access Notice (in the form attached hereto as Exhibit A) on its website, and at its main laboratory facility.

Access features at the Precision Diagnostics laboratory facility include:

• Convenient off-street parking designated specifically for disabled persons.
• Curb cuts and ramps between parking areas and buildings.
• Level access into first floor level with elevator access to all other floors.
• Fully accessible offices, meeting rooms, bathrooms, and public waiting areas.
• A full range of assistive and communication aids provided to persons with impaired hearing, vision, speech, or manual skills, without additional charge for such aids (described in Sections C and D).

C. Procedures for Communicating Information to Persons with Sensory Impairments:

1. Generally: Precision Diagnostics will take such steps as are necessary to ensure that qualified persons with disabilities, including those with impaired sensory or speaking skills, receive effective notice concerning benefits or services or written material concerning waivers of rights or consent to treatment. All aids needed to provide this notice are provided without cost to the person being served.
2. For Persons With Hearing Impairments: Qualified sign-language interpreter for persons who are deaf/hearing impaired and who use sign- language as their primary means of communication, the following procedure has been developed and resources identified for obtaining the services of a qualified sign-language interpreter to communicate both verbal and written information:

• • • Precision Diagnostics will utilize a local Sign Language Interpreting Service
    • Teletypewriter (TTY): A TTY is an electronic device for text communication over a telephone line, which transmits texts live, via a telephone line, to a compatible device. Precision Diagnostics provides TTY services if necessary to assist persons with hearing impediments.

3. For Persons With Visual Impairments: Upon request, Precision Diagnostics staff will communicate the content of written materials concerning benefits, services, waivers of rights, and consent to treatment forms by reading them out loud to visually impaired persons. Alternatively, Precision Diagnostics staff will also, upon request and where possible, enlarge printed materials for visually impaired persons.
4. For Persons With Speech Impairments: TTY support and computers are available to facilitate communication concerning program services and benefits, waivers of rights, and consent to treatment forms.

Policy and Procedures for Communicating Information to Persons of Limited English Language Proficiency: Policy:

It is the policy of Precision Diagnostics to provide communication aids (at no cost to the person being served) to Limited English Proficient (LEP) persons, including current and prospective patients, clients, family members, interested persons, et al., to ensure them a meaningful opportunity to apply for, receive or participate in, or benefit from the services offered. The procedures outlined below will reasonably ensure that information about service, benefits, consent forms, waivers of rights, financial obligations, etc., is communicated to LEP persons in a language which they understand. Also, they will provide for an effective exchange of information between staff/employees and patients/clients and/or families while services are being provided.

Procedure:

Precision Diagnostics has designated the Director of Client Services to be responsible for implementing methods of effective communication with LEP persons. The Director of Client Services will:

• Maintain and routinely update a list of all bilingual persons, organizations, and staff members who are available to provide bilingual services, and
• Develop written instructions on how to gain access to these services, i.e., contact persons, telephone numbers, addresses, languages available, hours available, fees and conditions under which the person(s) are available.
• In order to ensure effective communication and to protect the confidentiality of (client/patient) information and privacy, the (client/patient) will be informed that the services of a qualified interpreter are available to him/her at no additional charge. The choice of the (client/patient) and assistance of an interpreter will be documented after every encounter.

Please direct any questions or concerns regarding communication with LEP persons to:

• Director of Client Services
• Precision Diagnostics
• 4215 Sorrento Valley Blvd., San Diego, CA, 92121
• Phone: 800-635-6901 ext. 534

Notice of Non-Discrimination:

Precision Diagnostics does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, or national origin, or on the basis of disability or age from access to, or receipt of, Precision Diagnostics laboratory testing services and the benefits thereof, whether the testing services are carried out by Precision Diagnostics directly or through a contractor or any other entity with whom Precision Diagnostics arranges to carry out those services. Likewise, Precision Diagnostics does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, or national origin, or on the basis of disability or age, from opportunities for employment by Precision Diagnostics.

• This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Regulations of the U.S. Department of Health and Human Services issued pursuant to the Acts, Title 45 Code of Federal Regulations Part 80, 84, and 91.

Access Notice:

As a clinical reference laboratory located and operating in San Diego, California, Precision Diagnostics provides laboratory testing on patient samples generally shipped via air carriers as well as local couriers from the unaffiliated offices of its health care practitioner customers. Precision Diagnostics therefore has very limited in-person interaction with patients for whom it performs its laboratory testing services. However, for patients and clients and others throughout the United States who may from their respective locations seek access to, or receipt of, Precision Diagnostics laboratory testing services and the benefits thereof, or otherwise to access or communicate with Precision Diagnostics, Precision Diagnostics also strives to make such communications accessible to and usable by disabled persons, including persons with impaired hearing and vision, through assistive and communication aids provided without additional charge (as described in Sections C and D). In addition, Precision Diagnostics has implemented access features at its San Diego clinical reference laboratory facility, as follows:

Access features at the Precision Diagnostics laboratory facility include:

• Convenient off-street parking designated specifically for disabled persons.
• Curb cuts and ramps between parking areas and buildings.
• Level access into first floor level with elevator access to all other floors.
• Fully accessible offices, meeting rooms, bathrooms, and public waiting areas.
• A full range of assistive and communication aids provided to persons with impaired hearing, vision, speech, or manual skills, without additional charge for such aids (described in Sections C and D).

Accommodations for Communicating Information to Persons with Sensory Impairments:

Precision Diagnostics will take such steps as are necessary to ensure that qualified persons with disabilities, including those with impaired sensory or speaking skills, receive effective notice concerning benefits or services or written material concerning waivers of rights or consent to treatment. All aids needed to provide this notice are provided without cost to the person being served.

• For Persons With Hearing Impairments: Qualified sign-language interpreter for persons who are deaf/hearing impaired and who use sign- language as their primary means of communication, the following procedure has been developed and resources identified for obtaining the services of a qualified sign-language interpreter to communicate both verbal and written information:
• For Persons With Visual Impairments: Upon request, Precision Diagnostics staff will communicate the content of written materials concerning benefits, services, waivers of rights, and consent to treatment forms by reading them out loud to visually impaired persons. Alternatively, Precision Diagnostics staff will, upon request and where possible, enlarge printed materials for visually impaired persons.
• For Persons With Speech Impairments: TTY support and computers are available to facilitate communication concerning program services and benefits, waivers of rights, and consent to treatment forms.
• Communicating Information to Persons of Limited English Language Proficiency:
• It is the policy of Precision Diagnostics to provide communication aids (at no cost to the person being served) to Limited English Proficient (LEP) persons, including current and prospective patients, clients, family members, interested persons, et al., to ensure them a meaningful opportunity to apply for, receive or participate in, or benefit from the services offered.
• Precision Diagnostics has designated the Director of Client Services to be responsible for implementing methods of effective communication.
• If you require any of the aids listed above, please let us know.

Patient Assistance Program

Precision Diagnostics has an obligation to perform Precision Testing Services on specimens submitted by health care providers for their patients, regardless of the extent or type of the patients’ insurance or ability to pay. Precision Diagnostics is sensitive to patient concerns regarding insurance coverage and affordability of medically necessary Precision Testing Services ordered by their treating providers. In addition, in the interest of patient care and safety. Precision Diagnostics also seeks to provide treating providers and their patients with clear and consistent information about patient responsibility for payment.

Financial Assistance & Payment Plans

Eligibility is determined upon review of your income and the U.S. Poverty Guidelines. To apply for financial assistance, download a 2020 Hardship application and mail or fax it to Precision Diagnostics, or contact our contact our Billing Department at 800-635-6901 Ext. 1.

Precision Diagnostics will work with you to setup a Payment Plan so you are able to make payments over time to pay your bill. To setup a Payment Plan, please contact our Billing Department at 800-635-6901 Ext. 1.

Specimen Processing Checklist

Specimen Processing Checklist: Online

1. Treating provider identifies patient to be tested based on medical necessity.
2. Patient takes a urine collection cup or Quantisal® oral fluid collection device and provides a sample.
   • To ensure no residual medication in the oral cavity, instruct patient to rinse mouth with water a minimum of 5 minutes prior to oral fluid collection. This is good practice and recommended, but not required.
3. Go to https://pdx.careevolve.com/
4. Login using your unique login identification which includes your Username, Password, and Location Code.
5. Once logged in, you will be directed to the “Results” tab.
6. To create a new test order, hover over the “Orders” tab and select “New Order”.
   • If the patient is an existing patient in CareEvolve, search by patient information (last name, DOB, etc.) and select the patient you’ve collected from. If the patient is new, hover over the “Patients” tab and select “Add Patient”.
     • If you are adding a new patient, fill in all required information. The required fields are in red and are bolded.
   • Once you’ve selected the existing patient or added a new patient, you will be directed to the “New Order” screen, which includes these following steps:
     • Step 1 – Demographics: Review provider and demographic information. Once confirmed, select “Next” at the bottom of the page.
     • Step 2 – Tests: Select your testing option. Options include “Test Group(s)” if one has been created, or select the individual test(s) based on medical necessity. To record POC results, search for “POC” and select. During Step 4, you will have the option to enter the POC results.
     • Step 3 – Medication(s): Select medication(s) by typing in the desired medication or selecting from the provided list.
     • Step 4 – Point of Care: Select the Point of Care (POC) result obtained in office using the drop down menu corresponding to each analyte that was tested in house. The options are: Positive, Negative, or Not Tested.
     • Step 5 – Diagnosis Code(s): Select diagnosis code(s) provided by the treating provider.
     • Step 6 – Review: Review order which includes: diagnosis code(s), testing, medication(s), collection time and date (which will be recorded automatically). Please update if the date of collection and the date of submission are different. Indicate the specimen collector in the “Coll. by” field, if different from the provider. The order should be documented and signed by the treating provider in the patient’s medical record.
     • Carefully review all fields to ensure information accuracy, then click on “Complete” at the bottom of the page.
     • Once submitted, you’ll receive an “Order Requisition/Label” pop-up. Print the barcode label. The label will include the patient’s full name, specimen ID, provider, date of collection, and date of birth.
     • Place the barcode label, which includes at least two patient identifiers, over the device.
     • Have the patient initial the barcode label once the label is affixed on the specimen device. This is good practice and recommended, but not required.
7. Please be sure that the specimen device is secure to prevent any leaks in transit to the laboratory.
8. Place the device into the biohazard specimen bag and ensure the bag is sealed.
9. Place the biohazard specimen bag into the shipping bag (FedEx/UPS) and affix the shipping label to the outside of the package.
10. Schedule a FedEx or UPS pickup by calling (800) 635-6901, Option 3.

Specimen Processing Checklist: Paper

1. Treating provider identifies patient to be tested based on medical necessity.
2. Patient takes a urine collection cup or Quantisal® oral fluid collection device and provides a sample.
   • To ensure no residual medication in the oral cavity, instruct patient to rinse mouth with water a minimum of 5 minutes prior to oral fluid collection. This is good practice and recommended, but not required.
3. Once the sample is collected from the patient, place the provided barcode label (located in the top left corner of the requisition and must include at least two patient identifiers) over the device. At minimum, two unique identifiers must be written on or attached to the collection device.
4. Have the patient initial the barcode label once the label is affixed on the specimen device.
5. Accurately and thoroughly complete the patient information on the requisition form. At minimum: please include full patient name, date of birth, and gender – matching the patient identifiers indicated on the barcode label.
   • You may also include a copy of the demographic sheet and send it in with the sample.
6. Indicate specimen type (urine or oral fluid) along with the date of collection.
7. Indicate the diagnosis code(s) provided by the treating provider.
8. Optional: To record POC results, please indicate in the appropriate area on the requisition form.
9. Select your testing option. Options include: “Perform Custom Profile” – if one has been established – or select “Do Not Perform Custom Profile” and select the individual test(s) based on medical necessity.
10. Select medication(s) from the provided list on the requisition form or make a copy of the patient’s medication list and place it inside the biohazard specimen bag.
11. Make a copy of the patient’s health insurance and place it into the biohazard specimen bag.
12. Have the treating provider sign and date the bottom of the requisition form before completion. This is good practice and recommended, but not required. The order should be documented and signed by the treating provider in the patient’s medical record.
13. Review the requisition form to ensure all necessary information has been completed.
14. Please be sure that the specimen device is secure to prevent any leaks in transit to the laboratory.
15. Fold the requisition form along with any other patient demographics (e.g. insurance, medication lists, etc.) into fourths, and place the information in the back pocket of the biohazard specimen bag.
16. Place the specimen in the front of the biohazard specimen bag and ensure the bag is sealed.
17. Place the biohazard specimen bag into the shipping bag (FedEx/UPS) and affix the shipping label to the outside of the package.
18. Schedule a FedEx or UPS pickup by calling (800) 635-6901, Option 3.