PATHWAY SERVICES

Follow the steps below to complete a new Pathway Request Form electronically and sign and submit via DocuSign

Step 1 — Access the Form

Click the link (or scan the QR code) to open the appropriate Pathway Request Form.

This action will activate the DocuSign authorization process.

Step 2 — Complete the DocuSign Authorization Process

Enter the information for the Authorized Signatory. (This step occurs before the form itself is displayed.)

*For all forms, you will be prompted to Enter the Authorized Ordering or Requesting Provider's name, individual NPI, and email address.

This step establishes the authorized signatory within DocuSign and accommodates both:

• Providers authorized to independently order and sign laboratory tests.
• Providers whose laboratory orders require review and signature by an authorized Supervising Physician.
  

Step 3 — Complete & Submit the Form for Signature

Once the Authorized Signatory information is entered, the selected Pathway Request Form will open in DocuSign.

Complete all required fields electronically, then select Submit to initiate the signature process.

Step 4 — Authorized Signatory Reviews & Signs

• If you are the Authorized Signatory: The signature page will appear automatically. Review and electronically sign the form to complete the DocuSign process.
• If you are submitting on behalf of the Authorized Signatory: DocuSign will send the Authorized Signatory an email containing a secure link to review and sign the completed form. Patient information and order details will not be included in the notification email.

The Pathway Request will be submitted for processing once the required electronic signature has been completed.

Step 5 — Confirmation & Access to Completed Forms

The Authorized Signatory will receive an email confirming completion of the DocuSign process, including a secure link to access the signed form.

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Submitting Additional Information for an Existing Pathway Request

DocuSign is intended for completing and submitting new Pathway Request Forms.

To submit additional medical records, documents, questions, or other information related to an existing Pathway Request, please use one of the following submission methods:

• Secure File Upload
• Secure Email
• Fax

Refer to the corresponding submission instructions on this page.

Follow the steps below to submit a Pathway Request Form by fax:

Step 1 — Download the Form

Select and download the appropriate Pathway Request Form using the links above.

You may also use a paper or PDF form provided by your Clinical Liaison or accessed by scanning the QR code in the BioConnetiX Clinical Pathway Resources for Treating Providers.

Step 2 — Complete the Form

1. Complete the form electronically and save it, or print the form and complete it by hand.
2. Sign and date using a handwritten signature or a secure, verifiable electronic signature (such as DocuSign).

Step 3 — Attach Patient Face Sheet & Required Medical Records

Include the patient’s face sheet and the medical records requested by the pathway subspecialist. (Required records are listed on the back of each Pathway Request Form.)

Step 4 — Add Additional Notes, Questions, or Comments

Include any notes, comments, or clinical or administrative questions from the Requesting Provider on the fax cover sheet or as separate pages within the fax.

Step 5 — Fax the Form

• Fax the completed form and all required attachments to (469) 599-7188
• Include an administrative contact for the Ordering Provider on the fax cover sheet so we can follow up regarding any administrative questions or additional information needed.
• In the fax cover sheet's "To" field, enter “New Pathway Request” or “New Pathway Request – [Provider Name]” if directing the request to a specific provider.

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Submitting Additional Information for an Existing Pathway Request

To submit additional medical records, documents, questions, or other information related to a previously submitted Pathway Request:

1. Prepare Your Information: Gather any additional records or documents. Questions or comments may be included on the fax cover sheet or as separate pages.
2. Identify the Existing Request: Include sufficient patient and request information on the fax cover sheet or within the attached documents to allow the additional information to be matched to the existing Pathway Request.
3. Complete the Fax Cover Sheet: In the "To" field, enter “Additional Information – Pathway Request” or “Additional Information – [Provider Name]” if directing the information to a specific provider. Include an administrative contact for the Requesting Provider in case follow-up is needed.
4. Send Your Fax: Fax the additional information and supporting documents to the same Pathway-specific fax number listed above.

Follow the steps below to submit a New Pathway Request Form by secure email:

Step 1 — Download the Form

Select and download the appropriate Pathway Request Form using the links above.

You may also use a paper or PDF form provided by your Clinical Liaison or accessed by scanning the QR code in the BioConnetiX Clinical Pathway Resources for Treating Providers.

Step 2 — Complete the Form

1. Complete the form electronically and save it, or print the form and complete it by hand.
2. Sign and date using a handwritten signature or a secure, verifiable electronic signature (such as DocuSign).

If submitting a handwritten form, please scan the completed form and save it as a PDF.

Step 3 — Attach Patient Face Sheet & Required Medical Records

1. Open your email interface.
2. Attach a PDF copy of the complete signed & dated Pathway Request Form.
3. Attach the patient’s face sheet and the medical records requested by the pathway subspecialist. (Required records are listed on the back of each Pathway Request Form.)

Step 4 — Add Additional Notes, Questions, or Comments

Include any notes, comments, or clinical or administrative questions from the Requesting Provider in the email body or as separate PDF attachments.

Step 5 — Email the New Pathway Request

In the email subject line, enter “New Pathway Request” or “New Pathway Request – [Provider Name]” if directing the request to a specific provider. Do not include patient names or other identifying information in the subject line.

Email the completed form, patient face sheet, and medical records to the appropriate email address identified below:

• Traumatic Brain Injury (TBI) Pathway Requests: TBI-PHI@BioConnetiX.com
• All Other Pathway Requests: PHI-Secure@BioConnetiX.com

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Submitting Additional Information for an Existing Pathway Request

1. Prepare Your Information: Attach any additional records or documents as PDF files. Questions or comments may be included in the email body.
2. Identify the Existing Request: Include sufficient patient and request information within the secure email or attachments to allow the additional information to be matched to the existing Pathway Request.
3. Enter the Email Subject: Use “Additional Information – Pathway Request” or “Additional Information – [Provider Name]” if directing the information to a specific provider. Do not include patient names or other identifying information in the subject line.
4. Send Your Email: Submit the additional information to the same Pathway-specific email address listed above.

Follow the steps below to submit Pathway Request Forms and supporting documentation through our secure upload system.

Step 1 — Download the Form

Select and download the appropriate Pathway Request Form using the links above.

You may also use a paper or PDF form provided by your Clinical Liaison or accessed by scanning the QR code in the BioConnetiX Clinical Pathway Resources for Treating Providers.

Step 2 — Complete the Form

1. Complete the form electronically and save it, or print the form and complete it by hand.
2. Sign and date using a handwritten signature or a secure, verifiable electronic signature (such as DocuSign).

If submitting a handwritten form, please scan the completed form and save it as a PDF.

Step 3 — Attach Patient Face Sheet & Required Medical Records

1. Click the Secure Digital Upload – New Pathway Request link below.
2. Enter the requested contact and verification information.
3. Upload the completed, signed, and dated Pathway Request Form.
4. Upload the patient's face sheet and required supporting medical records. (Required records are listed on the back of each Pathway Request Form.)

*You may upload multiple PDF files, including large attachments. All documents must be saved in PDF format before uploading.

Step 4 — Add Additional Notes, Questions, or Comments

Enter any additional notes, comments, or clinical or administrative questions from the Requesting Provider in the designated notes field or upload them as separate PDF attachments.

Step 5 — Submit Your Request

Review your information and attachments, then click Submit Request to complete your submission.

• Secure Upload Link: New Pathway Request

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Submitting Additional Information for an Existing Pathway Request

To submit additional medical records, documents, or information related to a previously submitted Pathway Request, follow the instructions above using the dedicated link below.

• Secure Upload Link: Additional Files or Information for an Existing Pathway Request

Follow the steps below to prepare and submit Pathway Request Forms when conventional internet or fax services are unavailable, using a mobile device with an available cellular or satellite data connection.

Step 1 — Print Forms in Advance

1. Select and download the appropriate Pathway Request Form using the links above.
2. For internet-down or grid-down preparedness: Print and maintain several copies of each applicable form as part of your practice's emergency operations supplies

Step 2 — Complete & Sign the Form

1. Complete the printed form by hand, including all required information.
2. Sign and date the form using a handwritten signature.

For rural clinics and internet-down environments, the secure upload system allows you to photograph completed forms using a mobile device instead of uploading PDF files. All photographs must be clear, complete, and legible to be accepted.

Step 3 — Upload the Firm & Available Medical Records

1. Using a mobile device with cellular or satellite connectivity, click the applicable Secure Upload link or scan the Upload Paper Form QR code.
2. Select “Secure Upload – Rural Clinic, Internet-Down, or Grid-Down.”
3. Enter the requested contact and verification information.
4. Take and upload clear photographs of the completed, signed, and dated Pathway Request Form, including all required pages.
5. Take and upload photographs of the patient's face sheet and available supporting medical records. (Required records are listed on the back of each Pathway Request Form.)

Ensure all photographed documents are complete, clearly legible, and properly oriented before submitting.

Step 4 — Add Additional Notes, Questions, or Comments

Enter any additional notes, comments, or clinical or administrative questions from the Requesting Provider in the designated notes field.

If required medical records are unavailable due to the outage, identify the missing documents and explain the circumstances in the notes field.

Step 5 — Submit Your Request

Review the information and uploaded photographs, then click Submit Request to complete your submission.