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HPV Requisition Form The Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm. 315 - Baltimore MD 21205 Phone 410-955-2405 CLIA License 21D0709511 State of Maryland License 471 Physician s Name Johns Hopkins History Number - Social Security Number Physician s Mailing Address Street/Suite Patient Name Last First MI Please fax results to Telephone Number Date of Birth Location Physician s UPIN Diagnosis Physician s Authorized Signature Comments Account Number Male Female...
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How to fill out John Hopkins HPV Requisition Form

01
Obtain the John Hopkins HPV Requisition Form from the official website or designated medical facility.
02
Fill in the patient's personal information, including full name, date of birth, and contact details.
03
Provide the insurance information, including policy number and provider details, if applicable.
04
Indicate the reason for the HPV test in the designated section of the form.
05
Sign and date the form to authorize testing and release of medical information.
06
Review the completed form for accuracy and completeness before submission.
07
Submit the form to the healthcare provider or laboratory as directed.

Who needs John Hopkins HPV Requisition Form?

01
Individuals seeking HPV testing for screening or diagnostic purposes.
02
Patients requiring documentation for insurance coverage of HPV testing.
03
Healthcare providers needing to refer patients for HPV testing.
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HPV Reflex testing (87623, 87624, 87625) for women aged 21-29 and over age 65 years with cervical cytology screening test results reported as ASC-US or LSIL, does not require a prior authorization. Medicare Advantage Plans HPV screening (G0476) for women aged 30-65 years does not require prior authorization.
Usually, it takes 1 to 3 weeks to get Pap and HPV test results. Most of the time, test results are normal. If you do not get the results of your Pap and HPV tests 3 weeks after the test, call your doctor's office to get the results.
An HPV test only takes a few minutes. It shouldn't hurt, but you might feel some discomfort or pressure when your doctor or nurse opens the speculum inside you. You might also feel a light scratching when they take the cells from your cervix.
Sample collection for HPV testing is typically performed during a gynecological examination, where the health worker, after inserting the speculum, removes a sample of cervical cells using a specially designed brush.
Types of follow-up testing include the following: Reflex testing—If you had an HPV test, a Pap test may be done on the same cells used for the HPV test. If you had a Pap test, an HPV test may be done on the same cells used for the Pap test. This is called reflex testing.
An HPV test for cervical cancer screening and Pap smear follow-up includes collecting a sample of cells from the cervix with a swab or small brush. To identify high-risk types of HPV, at-home tests use a swab to collect cells from the vagina. Three-site HPV at-home tests collect cells from the vagina, anus, and mouth.

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The John Hopkins HPV Requisition Form is a document used for submitting samples for testing related to human papillomavirus (HPV) at Johns Hopkins University.
Healthcare providers who are sending samples for HPV testing are required to file the John Hopkins HPV Requisition Form.
To fill out the form, complete all required fields including patient information, specimen details, and the reason for testing. Ensure to provide accurate and complete information before submission.
The purpose of the form is to provide necessary information for the accurate testing and diagnosis of HPV infections, as well as to ensure proper handling and processing of the specimen.
The form must include patient demographics, clinical information, specimen type, and any relevant clinical history or indications for testing.
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