Click Enter or Arrow to advance to next slide Women’s Health Requisition Guide We stand by our results because we know you depend on them. Click Enter or Arrow to advance to next slide

Click Enter or Arrow to advance to next slide Section A: Clinic Information Options Enter Clinic Name & Address OR Enter Clinic Account Number (provided in Enrollment Confirmation Letter) Affix custom Clinic Requisition Label (request via website at www.crestarlabs.com/order-supplies Specimens cannot be processed without Clinic Information Click Enter or Arrow to advance to next slide

Click Enter or Arrow to advance to next slide Section B: Sample Information Print Provider Name Date specimen collected Collector Initials Indicate Specimen Type as Vaginal Swab Specimens cannot be processed without Requesting Provider Click Enter or Arrow to advance to next slide

Section C: Patient Information Patient First & Last Name Patient DOB Patient Address (may provide from EMR printout) Current Medications (may provide from EMR printout) ICD-10 Codes (must reflect Medical Necessity) Insurance Information Req captures Primary Payor May provide from EMR printout Send copy of all payor cards Send copy of DL Must indicate Primary/Secondary Status Missing Information will result in reporting and billing delays Click Enter or Arrow to advance to next slide

Section D: Patient Clinical History Diagnostic Factors Last Cycle Pregnancy status Recurrent BV concerns Recurrent Trichomonas concerns Recurrent Candidiasis concerns Data required for improved diagnostic accuracy Click Enter or Arrow to advance to next slide

Section E: Pathogen Testing Options May order Comprehensive Panel. Includes all pathogens within Pathogen Panels and Group B Strep May order individual or combination of Pathogen Panels May add Pathogen Specific Tests Rules for Medical Necessity must be followed when ordering Panel(s) Click Enter or Arrow to advance to next slide

Section F: Authorization Patient Signature – Required for billing purposes Provider Signature – Required for billing purpose Specimens will not be processed without a Provider Signature Requisitions missing signatures will be faxed to the clinic to request a signature. Specimens will be processed once the requisition is faxed back with a valid signature. Click Enter or Arrow to advance to next slide

Click Enter or Arrow to advance to next slide Lastly: Requisition Labels Used to connect specimen to paperwork for integrity purposes Affix label from requisition to collection device Label device with at least 1 additional unique identifier Do not label device lids Acceptable Unique Identifiers Patient Full First & Last Name Patient DOB Requisition label Specimens lacking 2 unique identifiers will be marked as such. Integrity of the specimen source cannot be confirmed. Click Enter or Arrow to advance to next slide