Palmetto GBA Test Identifier (PTI) Application Guide

Fields ReferenceContact Information FieldsField NameNameEmailPhonePhone Ext.Description Column entry is required. Provide the name of the laboratory contact that will manage thisdocument. Acceptable format: free-text entry. Confidential: This information will not be exposed to public view. Column entry is required. Provide the email address of the laboratory contact that willmanage this document. Acceptable format: free-text entry. If no email address is available enter"email@yourlab.com." Confidential: This information will not be exposed to publicview. Column entry is required. Provide the phone number of the laboratory contact that willmanage this document. Acceptable format: alphanumeric. Confidential: This information will not be exposed to public view. Column entry is optional. Provide the phone extension of the laboratory contact that willmanage this document. Acceptable format: alphanumeric. Confidential: This information will not be exposed to public view.Fax Column is required if Email column entry ="email@yourlab.com" otherwise column is optional. Provide the fax number of the laboratory contact that willmanage this document. Acceptable format: alphanumeric. Confidential: This information will not be exposed to public view.Medical / Lab Director InformationField NameNameStreet Address 1Description Column entry is required. Provide the name of the medical/lab director/CLIA # licenseholder in the performing laboratory. Acceptable format: free-text entry. This information will be exposed for public view. Column entry is optional. Provide the street address of the medical/lab director/CLIA #license holder's office. If the address is different from that of the performing laboratory,enter it here. Acceptable format: free-text entry. Confidential: This information will not be exposed to public view.7