Required Forms for Patient Biopsies
UW OP Complete Forms Packet (Compilation of all required forms) (PDF)
- Request for Laboratory Study Form (PDF)
- Letter to Patients (PDF)
- Insurance Information Form (PDF)
- Diagram (PDF)
- Release of Health Information and Record (PDF)
Resources for Referring Dental Offices
- Biopsy Kit Request (PDF)
- Fee Schedule (PDF)
- Medicare Requirements (PDF)
How to Start
Complete the Biopsy Kit Request Form online and FAX it to us. If you are having issues with the FAX machine, call us at 206-543-4440. We will mail you a biopsy kit, which will contain:
- First-class postage paid box
- Formalin and/or transport medium
- Sealable bag for biopsy bottle
- Instruction slip
What to Send
Ship container-protected slides, tissue blocks, or formalin-fixed tissue to us with a copy of the Request for Laboratory Study form.
When sending formulin or IMF bottles, the patients’ name and date of birth (DOB) are REQUIRED on the bottles for processing. Refer to the following images:
Include medical and dental insurance information or a photocopy of the patient’s insurance cards. We accept assignment for state and federal health coverage such as Medicaid (DSHS), Medicare, and Tricare.
What will we do
- Examine and diagnose the specimen.
- Mail or fax a written report to your office.
- Bill your patient or your office for our services.
If your patient has any questions about their bill, they can call our billing office at 206.616.1359. We are happy to send statements to patients’ insurance companies upon request.