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NonInvasive Prenatal Testing Request & Consent Form: PATIENT DETAILS: L A ST NAME: GIVEN NAMES: DATE OF BIRTH (dd/mm/YYY): PHONE (Home): MOBILE: ADDRESS: POSTCODE: CLINIC AL INFORMATION: GESTATIONAL

How to fill out non-invasive prenatal testing request

How to Fill Out a Non-Invasive Prenatal Testing (NIPT) Request:

1. Obtain the appropriate form: Contact your healthcare provider or the laboratory conducting the NIPT to obtain the necessary request form. This form may be available online or you may need to visit your healthcare provider's office to obtain it.
2. Provide personal information: Fill out your personal details, including your full name, date of birth, contact information, and healthcare provider's name. Ensure that all information provided is accurate and up-to-date.
3. Indicate gestational information: Specify your gestational age at the time of the NIPT request. This is typically measured in weeks and can be determined by your healthcare provider or through ultrasound imaging.
4. Provide medical history: Disclose any relevant medical information, such as past pregnancies, genetic disorders, or hereditary conditions that may affect the testing or interpretation of the results.
5. Specify reasons for requesting NIPT: Clearly state the reasons for your interest in non-invasive prenatal testing. This can include a desire to assess the risk of specific genetic conditions or to obtain information about the sex of the fetus, among other reasons.
6. Obtain physician's signature: If required, ensure that your healthcare provider signs and dates the request form. Some laboratories may require physician authorization before proceeding with the testing.

Who Needs Non-Invasive Prenatal Testing (NIPT) Request?

1. High-risk pregnancies: Women who are identified as having a high risk for chromosomal abnormalities or genetic disorders may be recommended to undergo NIPT. This includes women who are advanced in age (typically over 35), those with a previous history of chromosomal abnormalities, or individuals with a family history of genetic conditions.
2. Unexplained fetal abnormalities: In cases where fetal abnormalities are detected through ultrasound or other diagnostic tests, NIPT may be suggested to further assess the genetic basis of these abnormalities.
3. Carrier screening: Individuals with a known family history of specific genetic conditions may opt for NIPT to assess the likelihood of passing on these conditions to their offspring.
4. Emotional reassurance: Some individuals may choose NIPT purely for peace of mind and to alleviate anxiety regarding potential genetic conditions or chromosomal abnormalities.

It is important to consult with your healthcare provider to determine whether NIPT is appropriate for your specific circumstances. They can provide guidance based on your medical history, personal preferences, and any other relevant factors.

For pdfFiller’s FAQs

What is non-invasive prenatal testing request?

Non-invasive prenatal testing request is a request for a procedure that analyzes fetal DNA in the mother's blood to screen for certain genetic conditions.

Who is required to file non-invasive prenatal testing request?

The request can be filed by pregnant women or couples seeking information about the genetic health of their unborn child.

How to fill out non-invasive prenatal testing request?

The request can typically be filled out by a healthcare provider and requires basic information such as the mother's medical history.

What is the purpose of non-invasive prenatal testing request?

The purpose of the request is to screen for genetic conditions in the fetus without the need for invasive procedures that carry risks.

What information must be reported on non-invasive prenatal testing request?

The request may require information such as the mother's age, gestational age, and any relevant medical history.

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