Pediatric/Adult Testing

How to Submit a Pediatric/Adult Sample

  1. Refer to Sample Requirements page.
  2. Print Signature Genomics Requisition form.

Page 1 of 2: Case Information

  1. Complete these required items on the requisition form: "Page 1: Case Information".
    1. Complete the Informed Consent required at the top of the page.
    2. Patient information. Patient sex is required for accurate analysis.
    3. Indication for study. ICD-9 codes are required for insurance bill cases.
    4. Indicate Test requested
    5. Parents' samples

      The requisition form is created to allow you to send in one requisition form if you are sending a patient's sample plus parental samples.
      • Fill in the probandís information at the top of page 1 of the requisition form.
      • Tell us when to expect the sample(s).
      • Next, complete the motherís and/or fatherís information in the spaces at the bottom left. Please fill in the draw date for each sample. Note that Signature Genomics requires billing information and authorization for each case when we are billing insurance. When sending parental samples, please fill out billing information (page 2 of the requisition form) for each parent. This will require each parentís signature.
    6. Referring physician and Referring institution
    7. Sample information

Page 2 of 2: Billing Information

  1. Select a method of billing- see page 2 of the Requisition form (ďBilling InformationĒ).
    1. The billing information page is required for each case received.
    2. Patient information:
      • Check the appropriate box to indicate whether the billing form corresponds to a parental sample or to the prenatal sample.
      • If the billing form corresponds to the parental sample, write in the motherís name (or the identifier under which the prenatal sample is sent). This allows Signature to link the cases together (for example, linking a pregnant patient to her male partner).
      • Fill in the patientís date of birth and name for whom the billing information follows.
    3. Select one of three billing options:
      1. Self-pay
      2. Institutional billing
      3. Request for Signature Genomics to Directly Bill Patient's Insurance
        • Tell us who should be contacted with the results of the benefits investigation.
        • The patient must sign to allow Signature Genomics to contact the insurance company. There is a box to check if the patient would like Signature Genomics to hold processing of the case while the insurance company is being contacted. If this box remains unchecked, analysis will proceed.
        • Fill in the insurance information and include an enlarged copy of the insurance card, front and back.
        • The patient must sign to accept financial responsibility. Signature Genomics cannot proceed with testing of a sample on insurance bill cases without this signature.

        • Our BIPA team is here to help! For any questions regarding insurance billing, please phone 1.877.506.1662.
    4. If the patient would like to determine if they qualify for additional discounts, they may fill out the requested information in the Patient Financial Assistance space. A signature is required. See the Financial Assistance Program page for additional information.

Shipping

  1. Ship sample with completed forms overnight at ambient temperatures to:
    Signature Genomic Laboratories
    2820 North Astor Street
    Spokane, WA 99207
    Signature Genomics accepts sample shipments Monday through Saturday.
  2. Email Signature Genomic Laboratories the Courier Tracking Number of the parcel.

Results will be faxed and mailed according to the details given on the Signature Prenatal Requisition Form. In the event of abnormal results, the referring clinician will also be contacted by telephone. For questions, please call 1.877.744.2447.


1.877.Sig.Chip (744.2447) or 509.474.6840  •  info@signaturegenomics.com

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Pursuant to applicable federal and/or state laboratory requirements, Signature Genomics has established and verified the accuracy and precision of its testing services.