How do I order?

Clinical diagnostic tests should be ordered by a doctor or other healthcare provider (physician assistant, nurse practitioner) for an individual with clinical features of autism spectrum disorder or other disorders of childhood development.
 

The Lineagen collection kit includes a Test Requisition Form/Informed Consent and buccal (cheek) swab with sample collection instructions. Completed kits can be sent to Lineagen by FedEx. Phlebotomy (blood draw) kits are also available and include prepaid FedEx labels.

For collection kits and support, please submit a request online or call us at 888.888.OPEN (888.888.6736).

Test Requisition Form/Informed Consent

Frontside: The blue (left) side of the form is for doctors/healthcare providers and the green (right) side of the form is for the parent/family to complete.

Backside: The back contains the informed consent, which families should review with the ordering provider or with a Lineagen genetic counselor by telephone.


 

 

Family Forms for NextStepDx PLUS

To be completed by each family member (typically biological mother and father) who will be providing a buccal (cheek) swab sample to assist the interpretation of the patient’s NextStepDx PLUS results. If needed, Lineagen can coordinate sample collection.

Lineagen’s licensed and certified genetic counselors are available at 801-931-6191 to answer questions about NextStepDx PLUS.

 

Sample Collection

Each collection kit includes one buccal (cheek) swab. A buccal swab is an easy and painless way to collect cells which contain DNA that can be used for genetic testing. In addition to easy collection, there are scientific advantages to using DNA from buccal swabs as well (Sdano, et al., 2014).

collection-kit
collection-kit-steps

Note: Samples will be rejected if not labeled/identified correctly and will require a re-swab from the patient.

The team at Lineagen will usually receive the kit within 2-4 days via FedEx. If needed, call us at (801) 931-6200 to schedule a FedEx pickup. At that time, a Lineagen representative will contact the family to review the billing policy based on each patient’s specific insurance plan and will offer genetic counseling by telephone.

Insurance Requirements

After you complete the test requisition form and select test(s) ordered, please submit the following insurance required documents:

  1. a copy of both sides of insurance ID card or EMR demographic sheet
  2. a copy of progress notes that indicate your patient’s diagnosis and reason for testing


Insurance required documents may be submitted via: