Get the free UNC Prenatal Cytogenetics Request Form - labs unchealthcare

This form is used to request prenatal cytogenetic testing, including chromosome analysis and amniotic fluid analysis, for patients referred by healthcare providers.

How to fill out unc prenatal cytogenetics request

How to fill out UNC Prenatal Cytogenetics Request Form

1. Obtain the UNC Prenatal Cytogenetics Request Form from the appropriate source.
2. Fill in the patient's personal information, including name, date of birth, and contact details.
3. Indicate the gestational age and the medical indication for the cytogenetics testing.
4. Complete the section regarding previous pregnancy history and any relevant family history.
5. Provide information about the referring physician, including contact information.
6. Specify the type of specimen being submitted, such as chorionic villi sampling (CVS) or amniotic fluid.
7. Sign and date the form, ensuring all required signatures are provided.
8. Submit the completed form along with the specimen to the appropriate lab address.

Who needs UNC Prenatal Cytogenetics Request Form?

1. Expectant parents seeking genetic testing for prenatal diagnosis.
2. Healthcare providers referring patients for cytogenetics testing.
3. Clinics and hospitals providing prenatal care.

For pdfFiller’s FAQs

What is UNC Prenatal Cytogenetics Request Form?

The UNC Prenatal Cytogenetics Request Form is a document used to request genetic testing for prenatal specimens, aimed at identifying chromosomal abnormalities in a fetus.

Who is required to file UNC Prenatal Cytogenetics Request Form?

Healthcare providers, typically obstetricians, genetic counselors, or other medical professionals involved in prenatal care, are required to file the UNC Prenatal Cytogenetics Request Form.

How to fill out UNC Prenatal Cytogenetics Request Form?

To fill out the form, providers must complete sections detailing patient information, clinical history, indication for testing, and any relevant family history, then submit it along with the specimen.

What is the purpose of UNC Prenatal Cytogenetics Request Form?

The purpose of the form is to facilitate the process of obtaining genetic testing for prenatal diagnoses, helping to identify potential genetic disorders or chromosomal abnormalities in the fetus.

What information must be reported on UNC Prenatal Cytogenetics Request Form?

The form requires reporting patient demographics, gestational age, type of specimen collected, detailed clinical history, medical indications for testing, and any family history of genetic disorders.