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PRENATAL QUAD SCREEN INFORMATION FORM Please have drawn between and. Please print all information. Addressograph Label Name Last First MI Physician Results to location Repeat Sample circle one Pregnancy History Yes G Acct No No AB LMP // Date of Birth // US Date // GA wks/day from US Weight Race circle one White Black Asian Hispanic Other In-Vitro Fertilization circle one Yes No If egg donor is other than patient need donors DOB or age at donation. // Current Pregnancy circle one Single...

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How to fill out prenatal quad screen information

01

Step 1: Obtain the necessary prenatal quad screen forms from your healthcare provider.

02

Step 2: Ensure that you read and understand all the instructions provided on the forms.

03

Step 3: Fill out your personal information, including your name, date of birth, and contact details, in the designated sections.

04

Step 4: Provide your healthcare provider with information about your medical history, any previous pregnancies, and any relevant family history.

05

Step 5: Complete the section that requires information about the gestational age of the pregnancy.

06

Step 6: Follow the instructions to provide blood samples for the quad screen test. This may involve a simple blood draw or other specific instructions provided by your healthcare provider.

07

Step 7: Double-check all the information you have entered and make sure it is accurate and legible.

08

Step 8: Return the completed forms to your healthcare provider as instructed.

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Step 9: Await the results of the prenatal quad screen, which will be communicated to you by your healthcare provider.

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Step 10: Discuss the results with your healthcare provider and follow any further instructions or recommendations they provide.

Who needs prenatal quad screen information?

01

Expectant mothers who want to assess their risk of having a baby with certain genetic conditions or birth defects.

02

Pregnant women who are part of high-risk groups, such as those over the age of 35 or with a family history of genetic disorders.

03

Individuals who have previously had a child with a genetic condition or birth defect.

04

Women with abnormal ultrasound findings or other indications of potential fetal abnormalities.

05

Individuals who desire more information about the health of their baby during pregnancy.

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What is prenatal quad screen information?

Prenatal quad screen information is a test that provides information about a woman's risk of carrying a baby with certain genetic conditions.

Who is required to file prenatal quad screen information?

Expectant mothers are typically required to file prenatal quad screen information.

How to fill out prenatal quad screen information?

Prenatal quad screen information can be filled out by healthcare providers during prenatal visits.

What is the purpose of prenatal quad screen information?

The purpose of prenatal quad screen information is to assess the risk of certain genetic conditions in a developing fetus.

What information must be reported on prenatal quad screen information?

Prenatal quad screen information typically includes maternal age, gestational age, and biochemical markers.

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