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THIS IS NOT A TEST REQUEST FORM. THIS TEST IS PERFORMED BY ARUP LABORATORIES The information below is required to perform phylogenetic (chromosome) studies. PATIENT HISTORY FOR PEDIATRIC/ADULT PHYLOGENETIC
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microarray cytogenetic ARUP Dysmorphic Fanconi Ataxia telangiectasia mercydiagnostics PDD aCGH Genomic karyotype Trisomy ext Buccal variant Recurrent disabilities Pervasive developmental Infertility Diagnostics abnormality Genital congenital anemia Autism

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