|^~\&eCWGHSA-00059940GH ScreeningCLIA#05D230212920250521145513ORMO016560920556T2.31829912337110605RLGYUPTCXWecwTestXLZHXLZH19780411FAsian37867 Murphy StDenverCO929325102038467valtesting_06@yopmail.comMexican American11365478241WillisSam273491C1Scenario_06Valtesting_06678, Shalimar RoadFremontCA9455519400418USelfNW202605080701571365478241WillisSam1SQA6854707657ecw3817496352ecwCRCSHIELD CRC BLOOD-BASED COLORECTAL CANCER SCREENING202605101820261365478241WillisSam0CHEMISTRY101I10Z12.12Encounter for screening for malignant neoplasm of colon1STYesMNDo you Attest to the confirmation of medical necessity?2STnoMCDBy selecting {{m_MCD_OPTIN}}, I opt in to receive the Multi-Cancer Detection (MCD) LDT results report which is not part of Shield CRC IVD and will be made available only upon patient signature on the authorization release form. VIEW MORE at ordershield.com/sf3STInpatientSTATUSPatient Status:Outpatient3ST5566-0000-7799000776655BCK3STYESSMS4STIn OfficeLOCBlood Sample Location5STEnglishLANGPatient Language6STDPA21232334PAPrior Authorization Code (if available)
App:
eCW
Facility:
GHSA-00059940
Msg Time:
May 21, 2025 14:55:13
Control ID:
6560920556
Type:
ORM_O01
Version:
HL7 v2.3
Account #
ID
, 8299123371
PHN
10605
Sex
F
Name
RLGYUPTCXWecw,
TestXLZH XLZH
DOB
April 11, 1978
Address
37867 Murphy St Denver CA 92932
Phone
5102038467valtesting_06@yopmail.com
Location
Account Type
Attending Provider
Willis, Sam
License #: 1365478241
Diagnosis Coding Method
I10
Diagnosis Code
Z12.12
Diagnosis Description
Encounter for screening for malignant neoplasm of colon
Order Date
May 8, 2026 07:01:57
Order ID
Order Status
Response Flag
Entered By
,
Ordered By
Willis, Sam
License #: 1365478241
Report Name
SHIELD CRC BLOOD-BASED COLORECTAL CANCER SCREENING