UT Genetics Center
Laboratory Requisition Forms
- Molecular Diagnostic Laboratory Requisition Form (.doc)
- Biochemical Diagnostic Laboratory Requisition Form (.doc)
- Cytogenetic Diagnostic Laboratory Requisition Form (.doc)
- Hematology/Oncology Laboratory Requisition Form (.doc)
- Maternal Serum & Amniotic Fluid Biochemical Analysis Requisition (.doc)
Neurological: Presymptomatic Testing Consent form(.doc)
Neurological: Diagnostic Testing Consent Form (.doc)
Other Helpful Documents
- Advance Beneficiary Notice of Noncoverage (ABN) (.pdf)
- Form Instructions -- Advance Beneficiary Notice of Noncoverage (ABN) (.pdf)
- Pediatric/Prenatal/Adult Referral Form
- Oncology Referral Form
- CPT Coding Information (.doc)
- Clinical Laboratory Improvement Amendments Certificate
(CLIA Certificate) (.pdf)
Quick Links
The University of Tennessee Graduate School of Medicine
Division of Medical Genetics/ UT Genetics Center
UT Graduate School of Medicine
Building A, Suite 435
1930 Alcoa Highway
Knoxville, Tennessee 37920
Phone: 865.305.9030
Toll free: 1.800.325.3894
Fax: 865.305.6675