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  • About the Test
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  • APOL1 Genetics Test Requisition

  • Please complete only one request per person.

  • Patient Information

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  • Collection Information

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  • Test Information

  • Referring Physician Information

  • The APOL1 genetic test is provided for a fee of $375. Submitting this requisition form acknowledges your responsibility for the total payment of the genetic test. This amount should not be reimbursed at the Medicare rate as this charge should not be submitted to insurance companies nor will patients be billed directly.  Request for testing and payment must be fulfilled by a clinical entity. An invoice cannot be sent directly to a patient.

  • Specimen and Shipping Requirements

  • Acceptable specimens include:

    Potential living donors and patients (results provided within 7 days of receiving the samples)

    Peripheral blood: At least 2 Lavender top (EDTA) tubes or Yellow top (ACD-A) tubes. Shipped overnight at room temperature.

    Please ensure the mailer meets all IATA and DOT requirements for shipping of diagnostic specimens through FedEx or UPS.

    Please email us at hlalab@wakehealth.edu to discuss specimen requirements for deceased donors and rapid genetic testing (same business day).

    All samples must have two patient identifiers, specifically the patient’s name and date of birth. Each sample must be accompanied by a printed copy of this completed requisition form, which you will receive by email after submitting. The ordering provider must agree to the terms of agreement outlined below.

    Sample with a printed copy of the completed requisition form should be shipped to:

    HLA/Immunogenetics Laboratory
    145 Kimel Park Drive, Suite 250
    Winston-Salem, NC 27103

    Please contact HLA/Immunogenetics Laboratory at +1.336.716.4456.

  • How would you like to receive your results?

  • Terms of Agreement

  • Enter the name of the person completing this form.
  • Enter the preferred email address for receiving a copy of this form.
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  • This field is for validation purposes and should be left unchanged.

Rapid APOL1 genetic testing services are protected by US 20130079244, Methods of predicting predisposition to or risk of kidney disease. Contact Wake Forest Innovations for licensing opportunities. © 2023 Wake Forest Baptist Medical Center. All Rights Reserved.

Barry Freedman, MD, Professor of Internal Medicine (Nephrology), Wake Forest School of Medicine, is entitled to royalties from the APOL1 assays processed at Wake Forest Baptist Medical Center’s laboratory.