TEST REQUEST FORMS:
Complete the appropriate indication-specific test request form. To ensure prompt specimen processing, please provide accurate and complete information, including enlarged copies of insurance cards and prior authorization information if needed.
Forms linked below are type & print interactive.
PRENATAL DIAGNOSTIC: amniotic fluid, chorionic villi (CVS), fetal tissue
PRENATAL SCREENING: maternal serum
POSTNATAL: blood, buccal, DNA, skin
MALE INFERTILITY: blood
ONCOLOGY: bone marrow, cancer blood, lymph node, paraffin embedded tissue, solid tumor, urine/bladder washings
FINANCIAL / INSURANCE FORMS:
- Pre-Authorization for Genetic Testing Request Forms [codes updated 1/2014]
- Advanced Beneficiary Notice of Noncoverage (ABN)
- Self-Pay Waiver of Services
CONSENT and AUTHORIZATION FORMS:
- Informed Consent for Genetic Testing
- Informed Consent for Genetic Testing - Spanish
- Authorization for Release of Genetic Information (reports)
Adobe Acrobat Reader is necessary to view/print all forms.
- Option 1:
Specimen Pickup, local area
- Option 2:
- Option 3:
- Option 4:
Toll free: 1-800-656-3937 x95070
Urgent calls: 402-679-1909
After hours pager: 402-888-0351
Human Genetics Laboratory
UNMC Shipping & Receiving Dock
668 South 41 Street
Omaha, NE 68105
Monday through Friday
Specimens accepted on all weekends and holidays.