PROCEDURE FOR SPECIMEN SUBMISSION ORAL PATHOLOGY CONSULTANTS

The following policies and procedures MUST be followed to ensure the optimum condition of patient specimens for testing.

PLEASE INCLUDE COMPLETE BILLING INFORMATION

WE DO NOT BILL DENTAL INSURANCE- WE ONLY BlLL MEDICAL INSURANCE

The patient will be responsible for ALL services not covered by their insurance.

• After the biopsy, the tissue must be immediately placed in the fixative
• Io the event more than one location is biopsied, a separate specimen bottle MUST be used for each location with the bottle and form(s) appropriately labeled with corresponding #1, #2, #3, or A, B, C; or each specimen must be suitably marked i.e., sutures.
• The kit provided has a non-breakable plastic bottle with screw cap and appropriate hazard The CAP MUST BE TIGHLY SECURED. It also must include the PATIENT'S FULL NAME, DATE OF BIRTH (DOB), LOCATION OF SPECIMEN, DATE OF SPECIMEN, and DOCTOR'S NAME
• The bottle is placed in the plastic bag with absorbent strip then The bag is then placed in the padded envelope, labeled with our address, mailing permit and hazardous chemical label.
• There MUST be included in the envelope and accompanying the specimen, a completely filled out BIOPSY REQUEST FORM. THIS FORM MUST INCLUDE:
  1. The patient's full legal name (no initials or nicknames). Last name, first name.
  2. The patient's complete address and phone
  3. Birth date-month/day/year, patient's sex (race optional).
  4. ALL MEDICAL INSURANCE INFORMATION, including Medicaid. Medical Assistance Numbers. PLEASE ATTACH FRONT & BACK COPY OF MEDICAL CARDS.
  5. The date the biopsy/specimen was taken or obtained (information can be found below medical history)
• DOCTOR'S INFORMATION ON THE FORM MUST INCLUDE:
  1. DOCTOR'S NAME
  2. DOCTOR'S SIGNATURE INDICATING A REQUEST FOR SERVICE
  3. DOCTOR'S ADDRESS and TELEPHONE NUMBER (Practice Name (optional, but helpful)
  4. SPECIAL REQUEST: (Written Report Only( will call with significant diagnosis), Fax or Email Report (please include Fax Number and/or email Address, Request for kits,prefer kits to be ordered onlifle)
• A history of the condition should be included with the location and clinical appe This should be followed by a clinical diagnosis.
• The specimen is then mailed by S. Mail or sent by designated courier to:

ORAL PATHOLOGY CONSULTANTS

Department of Oncology and Diagnostics Services 650 West Baltimore Street 7N
Baltimore, MD, 21201
ORAL PATHOLOGY CONSULTANTS

REMINDERS:

• Include copies of the Medical Insurance

Laboratory Service Request Form - UMSOD