If you’re an existing Caris client and would like to order Molecular Intelligence™ services, submit the requisition (found below), pathology report, patient history and insurance information via fax or electronically through MI Portal.
If you would like to order Molecular Intelligence™ services for the first time or if you would like more information, please contact Client Services to set up your client profile.
Tumor Profiling Forms
Select the appropriate country below. If your country is not listed, please contact Europe Client Services
Europe, Israel, Turkey & South America
Requisition Form Instructions
- Complete the Patient, Client and Pathology Information sections of the Requisition Form, as well as listing any additional physicians that need to be copied when the final report is released.
- Obtain the payment and demographic information for the patient. An agreed payment method is required prior to testing.
- Document the Specimen Information, including Site, Date and Time of Collection. Also, detail the patient’s current treatment status and past therapies.
- Select either the Molecular Intelligence Services Comprehensive Profile or individual assay box. A molecular profiling service must be selected in order for testing to be performed.
If submitting a Fresh Specimen:
- Attach the patient insurance information, pathology report and clinical history/most recent notes, and fax with the Requisition Form to 1.866.479.4925 before placing in the shipper kit.
- Call Molecular Intelligence Client Services at 1.888.979.8669 to arrange pick-up.
If submitting an Archived Specimen:
- Collect the patient insurance information, pathology report and clinical history/most recent notes, and fax with the Requisition Form to 1.866.479.4925.
- Contact your pathology department to request specimen be sent to Caris for molecular profiling.
Caris Client Services will handle all necessary block, slide or fresh tissue coordination with pathology including:
- Shipment of paraffin block/slide or fresh frozen kits, including pre-paid shipping labels and delivery of dry ice as needed
- Specimen requirements
- Follow-up/tracking on specimen receipt
- Any further authorizations or necessary pathology information
*If a surgical procedure is planned, provide the anticipated specimen information, date and time of procedure and the location/facility information.
Molecular Intelligence™ Services, from Caris Life Sciences®, provides evidence-based tumor information that associates biomarker status to agents with potential clinical benefit or potential lack of clinical benefit. Agents associated with clinical benefit are presented based on NCCN Compendium™ inclusion, relevance of tumor type, level of published evidence and strength of biomarker expression. Report information must be considered in conjunction with all other relevant information in respect of a given patient before determining the appropriate course of treatment. The selection of agents for re-treatment from prior chemotherapy regimens lies with the treating physician and must be done with careful consideration. Caris Molecular Intelligence Services were developed and its performance characteristics were determined by Caris Life Sciences, a medical laboratory CLIA-certified in compliance with the U.S. Clinical Laboratory Amendment Act of 1988 and all relevant U.S. state regulations. Caris Molecular Intelligence Services have not been approved by the United States Food and Drug Administration.