PGx Test Requisition
Pharmacogenomic testing shows how a patient's genes may affect medication response, metabolism, tolerability and gene-drug interactions.
Have these ready
- Patient detailsName, date of birth, address and primary insurance.
- Ordering providerName, NPI, practice name and phone.
- MedicationsThe patient's current and future medications.
- The patient's diagnosesThe form lists the ICD-10 codes that fit each medication. You pick the ones that apply.
- The provider's signatureThe ordering provider confirms medical necessity and signs on screen.
After you order
- Sample collectionA cheek swab is collected and submitted to the laboratory.
- Lab analysisThe sample is analyzed to identify genetic factors that may influence medication response.
- Report deliveryProviders receive an easy-to-review report with medication guidance to support clinical decision-making.
- Ongoing supportNona Scientific's team is available to help with workflow, ordering, report access and follow-up questions.
PGx reports support provider review of medication options, alongside the patient's clinical history, current medications, diagnosis and professional clinical judgment.