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  • COLOGUARD® ORDER REQUISITION FORM
    PROVIDER INFORMATION ORDER INFORMATION PATIENT AUTHORIZATIONS, ASSIGNMENT OF BENEFITS (AOB) FINANCIAL RESPONSIBILITIES I authorize Exact Sciences Laboratories (Exact) to bill my insurance health plan and furnish them with my Cologuard order information, test results, or other information requested for reimbursement
  • How to Get a Cologuard® Test | Collected at Home, Tested in the Lab
    If you’re 45+ and at average risk for colon cancer, learn how to order the Cologuard test — either online or through your health care provider Either way, we’ll deliver your prescribed kit right to your door
  • ORDERING COLOGUARD VIA EHR - Exact Sciences
    Please note that most EHR systems allow you to create a test requisition form template to order tests These steps are provided as a convenience for adding a template to order Cologuard If you need further assistance please contact your EHR vendor for support
  • Laboratories | Exact Labs
    Cologuard® is an FDA-approved, noninvasive multi-target stool DNA test for colorectal cancer screening The performance characteristics of Cologuard were established in a prospective, multi-site, point-in time study (NCT01397747) of average risk adults ages 50-84
  • COLOGUARD ORDER EXACT SCIENCES LABORATORIES, LLC REQUISITION FORM
    Order I authorize Exact Sciences Laboratories (Exact) to bill my insurance health plan furnish them with my Cologuard order information, test results, or other information requested for reimbursement
  • COLOGUARD ORDER. REQUISITION FORM - formsbox. com
    Secure Fax Number To receive results for this order, please provide secure FAX number only ICD10 Code Z12 11 and Z12 12 Encounter for screening for malignant neoplasm of colon [Z12 11] and rectum [Z12 12] Other(s)
  • Cologuard Test Order Requisition Form - Horizon BCBSNJ
    Ordering practitioners should report the diagnosis code(s) that best describes the reason for performing the test Z12 11 and Z12 12 (Encounter for screening for malignant neoplasm of colon [Z12 11] and rectum [Z12 12]) I am a licensed healthcare provider authorized to order Cologuard
  • Cologuard® Order Requisition Form and Process | Cologuard® For HCPs
    Download a Cologuard® test order requisition form as a PDF, explore our electronic ordering options, or receive easy access to patient information and results For adults 45+ At Avg Risk Rx Only See Risk Info
  • HERE S WHAT TO DO WITH YOUR CUSTOMIZED ORDER FORM. - svimed. com
    CUSTOMIZED ORDER FORM 1 Print or Save this PDF le 2 Take the printed copy to your healthcare provider or email the PDF le to them 3 Talk to your healthcare provider about whether or not Cologuard is right for you 4 If your healthcare provider decides Cologuard is right for you, ask them to complete the order form on page 2
  • Cologuard® and Cologuard Plus™ Colon Cancer Screening Tests | Collected . . .
    Quickly navigate the next steps of your Cologuard journey after you’ve ordered your kit Effective, noninvasive colon cancer screening that requires no prep — just send back your sample to us for testing Request your Cologuard® test today Already have your at-home collection kit?





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