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Screen 1st or 2nd trimester NIPT HTN Family Hx of Fetal anomaly Other Medical Hx Suspected placenta accreta 4. Blood type/Rh HIV antibody screen HBsAg are required. CVS 11-13 6/7 wks Amniocentesis 16 wks Other MFM Consult Indication Preconception Consult Indication Diabetic Education and monitoring includes MFM consult Other Dietary Consult AT PAVILION FOR WOMEN LOCATION ONLY Consult Transfer of Care 3. PATIENT AND REFERRING INFORMATION ALL FIELDS ARE REQUIRED. INCOMPLETE FORMS WILL DELAY...
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How to fill out request for maternal-fetal medicine
How to fill out request for maternal-fetal medicine
01
Gather all necessary medical information related to the patient's condition and medical history.
02
Identify a specialist or healthcare provider specializing in maternal-fetal medicine.
03
Contact the specialist or healthcare provider's office to schedule an appointment or consultation.
04
During the appointment, provide the specialist with all the gathered medical information, including any relevant test results or reports.
05
Discuss the specific reason for seeking maternal-fetal medicine, such as high-risk pregnancy, genetic concerns, or fetal abnormalities.
06
Follow any instructions or recommendations provided by the specialist regarding further diagnostic tests, screenings, or treatments.
07
Ensure to provide accurate contact information for future communication and follow-up.
08
Comply with any necessary paperwork or documentation required by the specialist or their office.
09
Inquire about insurance coverage and financial aspects of the maternal-fetal medicine services.
10
Keep all appointments and follow the specialist's advice and treatment plan for the best possible outcome.
Who needs request for maternal-fetal medicine?
01
Pregnant women with a higher risk of complications or medical conditions.
02
Women with pre-existing medical conditions that could potentially affect pregnancy or fetal development.
03
Couples or individuals with a family history of genetic disorders.
04
Women who have experienced previous pregnancy complications or adverse outcomes.
05
Individuals with concerns or abnormalities detected during routine prenatal screenings or ultrasounds.
06
Women of advanced maternal age (35 years or older) who may be at higher risk for certain pregnancy-related issues.
07
Patients referred by their primary healthcare provider due to specific concerns or risk factors discovered during regular prenatal care.
08
Individuals seeking specialized care for complex fetal conditions or abnormalities.
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What is request for maternal-fetal medicine?
Request for maternal-fetal medicine is a formal document submitted by a healthcare provider to request specialized care for pregnant women and their unborn babies.
Who is required to file request for maternal-fetal medicine?
Request for maternal-fetal medicine must be filed by the healthcare provider overseeing the pregnancy.
How to fill out request for maternal-fetal medicine?
Request for maternal-fetal medicine should be filled out with the patient's information, medical history, current condition, and reason for requesting specialized care.
What is the purpose of request for maternal-fetal medicine?
The purpose of request for maternal-fetal medicine is to ensure that pregnant women and their unborn babies receive the necessary specialized care to optimize health outcomes.
What information must be reported on request for maternal-fetal medicine?
Information such as patient demographics, medical history, current condition, referral details, and reason for specialized care must be reported on request for maternal-fetal medicine.
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