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I am a licensed healthcare provider authorized to order Cologuard. This test is medically necessary and the patient is eligible to use Cologuard. I will maintain the privacy of test results and related information as required by HIPAA. I authorize Exact Sciences Laboratories to obtain reimbursement for Cologuard and to directly contact and collect
Download a Cologuard® test order requisition form as a PDF, explore our electronic ordering options, or receive easy access to patient information and results. For adults 45+ At Avg. Risk. Rx Only. See Risk Info.
COLOGUARD® ORDER REQUISITION FORM. EXACT SCIENCES LABORATORIES, LLC. 145. E. Badger Rd, Ste 100, Madison, WI 53713 P: 844-870-8879 | www.exactlabs.com. Fax completed form to 844-870-8875. Provider & Order Information. Recommended: type all Provider information. Editable, printable PDF available at exactlabs.com. PROVIDER INFORMATION.
You can download and share resources with your peers directly from this page, or you can contact a rep to request materials. If you have any questions or need further assistance, please call our Customer Care Center at 1-844-870-8870 or chat online .
Z12.11 and Z12.12 (Encounter for screening for malignant neoplasm of colon [Z12.11] and rectum [Z12.12]) I am a licensed healthcare provider authorized to order Cologuard. This test is medically necessary and the patient is eligible to use Cologuard.
Please note that most EHR systems allow you to create a test requisition form template to order tests. These steps are provided as a convenience for adding a template to order Cologuard. If you need further assistance please contact your EHR vendor for support.
Once you and your healthcare provider have agreed Cologuard is right for you, then it's time to fill out the order form that's found at the end of this guide. You can complete it on your own, or your healthcare provider’s office can fill it out for you. Don't forget to ask your healthcare provider for the Cologuard Welcome Guide. Helpful ...
If you're ready to order Cologuard, click here to download an order form that can be completed and faxed to our lab (1-844-870-8875). Sign up to order Cologuard through a secure web-based portal, and also allows you to track patient orders, monitor compliance and access reports.
Download an Order Form (PDF) EPICCARE LINK PROVIDER PORTAL Signing up for our secure Web portal allows you to track patient orders, monitor test compliance, and access reports online.
PROVIDER INFORMATION ORDER INFORMATION. PATIENT AUTHORIZATIONS, ASSIGNMENT OF BENEFITS (AOB) & FINANCIAL RESPONSIBILITIES. I authorize Exact Sciences Laboratories (Exact) to bill my insurance/health plan and furnish them with my Cologuard order information, test results, or other information requested . for reimbursement.