Name of individual |
Date of birth |
Time and date specimen collection |
Time and date specimen receipt in the laboratory |
Specimen accession number or case number |
Race/ethnicity (where applicable) |
Indication for testing |
Test performed, including mutations tested |
Test result |
A statement interpreting the test result that include clinical implications and follow-up test, recommendations and/or genetic counseling indications |
Documentation if preliminary reports has been issued |
Notation of any deviation from laboratory standard practice |
Signature from laboratory director and other authorized individual |
Date of report |
Mean to contact laboratory director or designee |