Appendix B_Required Operational Fields_12.22.22_FINAL.xlsx
XLSX spreadsheet 18 KB Posted
- Attached to
- Q301--Copy of Tumor Molecular Testing Services 0004 Federal contract opportunity
- Solicitation number
- 36C10G24R0013
About this file
This document contains an appendix outlining required operational fields for tumor molecular testing services. Key details include required fields for ordering provider and facility information, patient demographics, specimen information, test details, order and result statuses, comments, attachments, and billing/account codes. It also lists the related federal contract opportunity as solicitation number 36C10G24R0013 for tumor molecular testing services with the Department of Veterans Affairs as the agency. The appendix provides a template for the data fields needed to order and process tumor molecular testing services under the terms of this federal contract.
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Text version
Sheet1
| Category | Field Name |
| Ordering Provider/Facility Information | |
| VA facility station name | |
| VA facility station ID | |
| Ordering Provider Name | |
| Ordering Provider email | |
| Additional Physician to be Copied | |
| Ordering Provider NPI | |
| Patient Demographics | |
| First Name | |
| Last Name | |
| Middle Initial | |
| Date of birth | |
| Patient SSN, Medical Record Number (MRN) or a second identifier | |
| Sex (biological) | |
| Patient Treatment Facility Name/Number | |
| Vendor Assigned Requisition Numner (patient specific) | |
| Current Dx / Patient History | |
| Suspected Diagnosis (entered by ordering provider) | |
| Patient ICD-10 codes | |
| Patient ICD-O-3 codes (Topology, Primary Site) | |
| Patient ICD-O-3 codes (Histology) | |
| Cancer Stage | |
| Prior/Current Therapies (optional) | |
| Additional Diagnosis Information (optional) | |
| Disease Status (metastatic, refractory, recurrent, relapse, or none) | |
| If previously tested by the Vendor, has the disease progressed (Y/N) | |
| Patient has received transplants | |
| Test(s) to be performed/Test Name | |
| Indication of Reflex Testing (when applicable) | |
| Specimen Information | |
| Specimen collection date/time | |
| Specimen type | |
| Specimen ID (specific to the received specimen and patient) | |
| Stage | |
| Pathologist's Name | |
| Patient Station Name/Number | |
| Alternate Specimen ID (if needed) | |
| Pathologist's phone number/fax number | |
| Diagnosis (confirmed by Contractor as assigned in provided pathology report and following Contractor pathology review) | |
| Sample Status (ex: In progress, reported, etc.) | |
| Date of sample status | |
| Date/Time of Specimen Collection | |
| Date/Time Specimen Received at Reference Lab | |
| Date Test signed and Reported | |
| Order Information | |
| Order status (ex: order placed, specimen received, completed, etc.) | |
| Order Status date | |
| Date Clinical Report Issued | |
| Comments & Attachments | |
| Comments | |
| Attachments (Pathology Report) | |
| Other Information | |
| Vendor Billint/Account Code (if applicable) | |
| IHC Ordering Selection | |
| Results Summary (TBD per assay) | |
| Costs |
File details come from the government source that posted it. Updated .