ARUP Laboratories Patient History Form for Non-Invasive Prenatal Testing (NIPT) 2017 free printable template

PATIENT HISTORY FORM FOR NON-INVASIVE PRENATAL TESTING (NIP) Patient Name Date of Birth Ordering Provider NPI# Physician FAX Physician Pager/Cell: Genetic Counselor Physician Phone Genetic Counselor

How to fill out ARUP Laboratories Patient History Form for Non-Invasive

How to fill out ARUP Laboratories Patient History Form for Non-Invasive Prenatal

1. Gather necessary personal information: Include the patient's name, date of birth, and contact information.
2. Fill in insurance details: Provide information regarding the insurance provider, policy number, and group number.
3. Document family history: Record any relevant family health history, especially concerning genetic conditions.
4. Include pregnancy history: Detail the number of previous pregnancies, outcomes, and any complications experienced.
5. Note current health status: Describe any current medical conditions, medications, or allergies that might affect the test.
6. Answer demographic questions: Enter information regarding ethnicity and any relevant ancestry.
7. Sign and date the form: Ensure the form is signed by the patient or legal guardian and is dated appropriately.

Who needs ARUP Laboratories Patient History Form for Non-Invasive Prenatal?

1. Expecting mothers who are considering non-invasive prenatal testing for genetic screening.
2. Patients with a history of genetic disorders or complications in previous pregnancies.
3. Women with advanced maternal age who are at an increased risk for chromosomal abnormalities.

People Also Ask about

How accurate is non-invasive prenatal testing NIPT?

NIPT is a highly accurate screen, however, it is not 100% accurate. It is not considered a diagnostic test (see What are my other options?). The detection rate is laboratory-dependent but is typically between 90-99% for high-risk, singleton (only one baby) pregnancies with false positive rates of less than 1%.

Is the NIPT test covered by insurance?

NIPT testing costs vary. Most health insurances cover most (if not all) of the cost. Many cover at least a portion. Check with your insurance provider before testing to be sure.

At what age is NIPT covered by insurance?

NIPT is considered medically necessary in the following circumstances: Maternal age or oocyte age of 35 years or older at delivery; or. Fetal ultrasound findings indicating an increased risk of aneuploidy; or. History of a prior pregnancy with a trisomy; or.

Is CVS the same as NIPT testing?

NIPT can also tell you whether you're having a boy or girl—often earlier than an ultrasound. Unlike traditional tests such as amniocentesis or chorionic villus sampling (CVS), NIPT does not require disturbing the placenta or amniotic fluid, which can slightly increase the risk of miscarriage.

How much is a NIPT test?

The cost of NIPT is $425 (screening for trisomy 21, 18 and 13).

How do I book a NIPT test?

Once you have received a completed NIPT request form from your doctor, you will need to book and pay for your NIPT. This can be done by using the Sonic Genetics payment portal.

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What is ARUP Laboratories Patient History Form for Non-Invasive Prenatal?

The ARUP Laboratories Patient History Form for Non-Invasive Prenatal is a document used to collect essential medical and family history information from expectant mothers to assess their risk for certain genetic conditions and ensure appropriate prenatal care.

Who is required to file ARUP Laboratories Patient History Form for Non-Invasive Prenatal?

Expectant mothers seeking non-invasive prenatal testing (NIPT) are required to file the ARUP Laboratories Patient History Form to provide necessary background information for the testing process.

How to fill out ARUP Laboratories Patient History Form for Non-Invasive Prenatal?

To fill out the ARUP Laboratories Patient History Form, patients should provide accurate personal information, including their medical history, family health history, and any relevant genetic conditions. It is essential to review the form carefully and provide complete information.

What is the purpose of ARUP Laboratories Patient History Form for Non-Invasive Prenatal?

The purpose of the ARUP Laboratories Patient History Form is to gather critical information that helps healthcare providers evaluate the risk for genetic disorders, make informed decisions regarding testing options, and tailor prenatal care accordingly.

What information must be reported on ARUP Laboratories Patient History Form for Non-Invasive Prenatal?

The information that must be reported includes the patient's personal health history, family medical history related to genetic conditions, details about previous pregnancies, and any other relevant health information that can impact prenatal care and testing.