Jpc Form 543 PDF Details

When dealing with the complexities of medical and pathology-related submissions, understanding the nuances and requirements of specific forms is essential. The JPC 543 form serves as a critical tool for entities looking to submit registry information to the Joint Pathology Center, located in Silver Spring, Maryland. This form, essentially an acknowledgment and receipt for registry submissions, outlines the process and sets the expectations straight—indicating that no histopathological review will be performed unless a separate, explicit request is made through a JPC Contributor's Consultation Request Form. It covers various important details such as the contributor's facility name and address, contact numbers, submission and receipt dates, patient information, and specifics about the materials sent, including the quantity and type of specimen (be it pathology/cytology slides, glass, paraffin blocks or wet tissue). Moreover, it clarifies the method of contact for any queries, emphasizing the use of encrypted email or toll-free calls, and underlines a clear directive not to use this form for consultation purposes. Navigating through its sections requires a careful approach, ensuring that all submissions to the Joint Pathology Center are correctly documented and acknowledged, streamlining the process for both contributors and the Center itself.

QuestionAnswer
Form NameJpc Form 543
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform543 online form fill for jpc

Form Preview Example

JOINT PATHOLOGY CENTER

ATTN: Registry Submissions

606 Stephen Sitter Avenue

Silver Spring, MD 20910-1258

JOINT PATHOLOGY CENTER (JPC) REGISTRY SUBMISSION ACKNOWLEDGEMENT AND RECEIPT

PAGE ___ OF

____PAGES

Please be advised that no histopathological review will be conducted by the JPC for these submissions. JPC policy is to provide such review only when expressly requested using a JPC Contributor's Consultation Request Form. If you have any questions regarding the status of a case, please contact JPC Customer Services at jpchelp@amedd.army.mil via encrypted email or call toll free at 1-855-393-3904.

DO NOT USE FOR CONSULTATION.

1. CONTRIBUTOR (Facility Name, Address)

 

 

 

2.

CONTACT NUMBERS

 

3. SUBMITTED (Date)

 

4. RECEIVED (Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2a. PHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2b. FAX

 

 

 

 

 

 

 

 

 

5a. PATIENT NAME (Last, First, MI)

5b. SSN

6. CONTRIBUTOR’S

7. MATERIALS SENT (Quantity)

8. REGISTRY

 

9.

 

10. JPC

 

 

11. JPC ACCESSION

 

 

(Last Four)

ACCESSION NUMBER

 

 

(POW, AGO,

 

RECEIVED

 

COMMENTS

 

 

NUMBER

 

 

 

 

 

KUW, IRQ,

( X one)

7a.

7b.

7c.

7d.

AFG, etc.)

 

 

PATH/CYTOL

GLASS

PARAFFIN

WET

 

Y

N

REPORT

SLIDES

BLOCKS

TISSUE

 

 

 

JPC FORM 543, DEC 2011

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