Instructions for administering the test

Where is PGxPredict™:WARFARIN test available?
The PGxPredict:WARFARIN test is available in all states except New York, California and Florida, where licensure is pending.

Forms

• Review with patient
• Have patient sign
• Keep copy for your records
• Give copy to patient

Fax Forms to PGxHealth (203-786-3418)

• Signed Informed Consent
• Completed Test Requisition
• Copy of patient's insurance card (front and back)

Sample Collection

1. Before obtaining the sample, write the patient's initials and date of birth on the lines below the barcode label on the FTA card.
2. Complete the sample collection as outlined below, using the kit contents provided.
• Select appropriate puncture site (finger).
• Using the alcohol wipe provided, clean the puncture site, PULL OFF yellow indicator as directed on tab and place in disposal. Have the FTA card ready.
• Position safety lancet firmly against puncture site. Hold lancet between fingers and place thumb on white activation button.
• To activate, press white activation button firmly into colored housing with thumb. Button will lock into housing and will not recoil. Do not pull lancet away from puncture site until after activation.
• Gently massage from base of finger to near the puncture site, holding hand below elbow level to obtain the required blood volume. Apply blood to all 4 sample areas on the FTA card.
• Allow sample to dry for 20 minutes and place in white envelope provided. Seal envelope.
3. Upon completion, place the white envelope containing the filled FTA card into the Infecon bag (verify that the desiccant is in the bag). Place the Test Requisition sheet in the outer sleeve of the Infecon bag, and return to PGxHealth.
   Please note that any samples that do not have the corresponding requisition form will not be processed, and may be destroyed.
4. Affix the preprinted billable stamp to the top of the shipping container and ship on the day of collection.
   
   SHIP TO:
   

   PGxHealth
   Attn: PGxPredict:WARFARIN
   100 Perimeter Park Drive, Suite C
   Morrisville, North Carolina 27560
   

List of materials included in the sample collection kit:

1. PGxPredict:WARFARIN Test Requisition
2. Test Instructions
3. Return shipping container – FTA Card Pouch
4. FTA Card
5. Lancet
6. Alcohol Prep Pads
7. Infecon Waterproof bags
8. ABN Form (for Medicare patients)
9. Consent Form
10. Desiccant
11. OTHER:
1. Fed Ex Pack
2. Pre-printed billable stamp

1-877-2-PGXHEALTH (877-274-9432)