Clinical Geneticist Template

Genomic Test Requisition Review Note

A professional Clinical Geneticist template for healthcare professionals.

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Specialty

Clinical Geneticist

Used

4 times

Type

Note

Last edited

6/24/2025

Created by

Samuel Adedero

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About this template

The Genomic Test Requisition Review Note is a specialized template used by clinical geneticists to document the review of genomic test requests. This template captures essential details such as the date of review, submitting provider information, specific tests requested, clinical indications, specimen details, and preliminary assessments. It ensures that all necessary documentation is complete and aligns with clinical guidelines. This template is crucial for maintaining accuracy and efficiency in genomic testing workflows, making it an invaluable tool for geneticists and related healthcare professionals. Ideal for use in Heidi, it streamlines the review process and supports high-priority genomic testing cases.

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**Genomic Test Requisition Review Note** **Date of Review:** 1 November 2024 - Full Review **Submitting Provider and Institution:** Dr. Emily Carter, MD, PhD, Genetics Department, St. Mary's Hospital, Contact: emily.carter@stmaryshospital.org, Referring Genetic Counselor: Jane Doe, MS, CGC **Test Requested:** Whole Exome Sequencing, Version 3.2, Laboratory Accession Number: WES-2024-00123, Clinical Assay **Clinical Indication:** Patient presents with developmental delay, hypotonia, and dysmorphic features. Suspected autosomal dominant inheritance. HPO terms: HP:0001263, HP:0001250. Urgent testing requested due to prenatal timeline. **Specimen Details:** Blood sample, arrived in good condition, collected on 28 October 2024, shipped within 24 hours, sample volume: 5ml, DNA yield: 50 ng/µl, chain of custody maintained. **Preliminary Assessment:** Requisition is complete and valid. Test choice aligns with clinical indication. All necessary documents, including consent forms and clinical summaries, are attached. Insurance preauthorization confirmed. Case meets institutional test eligibility guidelines. **Test Approval and Processing Status:** Test approved and batched for high-priority queue. Internal workflow code: HPQ-2024-EXOME **Initial Observations or Concerns:** No early red flags identified. Phenotype aligns with requested test. No prior testing duplication noted. Consent forms are correctly matched. No pre-analytical errors suspected.