Get the free PRENATAL DIAGNOSIS LABORATORY REQUEST FORM - wellingtongenetics co

Level 6, WSB, Wellington Hospital Phone: 049185352 Fax: 043855822 Email: WRGH CCD.org.NZ Website: www.wellingtongenetics.co.nz PRENATAL DIAGNOSIS LABORATORY REQUEST FORM (to be completed by the obstetrician)

How to fill out prenatal diagnosis laboratory request

How to fill out a prenatal diagnosis laboratory request:

1. Contact Information: Begin by providing your full name, contact number, email address, and any other relevant personal details requested on the form.
2. Patient Information: Fill in the necessary information about the patient, such as their full name, date of birth, and gender.
3. Referring Doctor: Include the name and contact details of the doctor or healthcare professional who is referring the patient for prenatal diagnosis.
4. Reason for Referral: Clearly state the reason or medical condition that necessitates the prenatal diagnosis laboratory request. This can include factors such as advanced maternal age, family history of genetic disorders, abnormal ultrasound findings, or any specific concerns.
5. Gestational Age: Indicate the current gestational age of the pregnancy in weeks or months. This information helps the laboratory prioritize and interpret the test results accurately.
6. Preferred Tests: Provide a list of the specific tests you are requesting. Common prenatal diagnosis laboratory tests may include non-invasive prenatal testing (NIPT), amniocentesis, chorionic villus sampling (CVS), or karyotyping.
7. Medical History: Include any relevant medical history of the patient or family that might impact the interpretation of the test results. This can include information about previous pregnancies, previous genetic testing, or known genetic disorders within the family.
8. Consent: Ensure that you have signed the consent form indicating your understanding of the tests being performed and your agreement to proceed with the prenatal diagnosis.
9. Other Instructions: If there are any additional instructions or requests, such as specific timing for the tests or any specific concerns, make sure to include them in the appropriate section.

Who needs prenatal diagnosis laboratory request?

A prenatal diagnosis laboratory request is typically needed by pregnant women who require specialized testing to assess the health and well-being of their unborn baby. This may include women with advanced maternal age, individuals with a family history of genetic disorders, or those with abnormal ultrasound findings. Additionally, healthcare professionals may also request this laboratory testing if they suspect a specific genetic condition or if there are any other concerns about the pregnancy that warrant further investigation. The prenatal diagnosis laboratory request helps initiate the appropriate tests and procedures to provide valuable information about the baby's health and to guide treatment decisions if necessary.

For pdfFiller’s FAQs

What is prenatal diagnosis laboratory request?

Prenatal diagnosis laboratory request is a form or request submitted by a healthcare provider to a laboratory for various tests performed on a pregnant woman to assess the health of the fetus.

Who is required to file prenatal diagnosis laboratory request?

Healthcare providers such as obstetricians, gynecologists, or genetic counselors are required to file a prenatal diagnosis laboratory request.

How to fill out prenatal diagnosis laboratory request?

The prenatal diagnosis laboratory request form should be completed with the patient's personal information, medical history, reason for testing, and specific tests requested.

What is the purpose of prenatal diagnosis laboratory request?

The purpose of the prenatal diagnosis laboratory request is to obtain important information about the health and development of the fetus during pregnancy.

What information must be reported on prenatal diagnosis laboratory request?

The prenatal diagnosis laboratory request should include the patient's name, medical record number, gestational age, relevant medical history, and specific tests requested.

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