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Prenatal Genetic Analysis Requisition Form For Laboratory Use Only Lab No. / TID Received By Date Time Patient Identification For Other Hospital / Company Use Only Patient Name H.N. Age Gender Male
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How to fill out prenatal genetic analysis requisition

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How to fill out prenatal genetic analysis requisition

01
Obtain the prenatal genetic analysis requisition form from your healthcare provider.
02
Fill out the patient information section accurately, including your name, date of birth, and contact information.
03
Provide your medical history and any relevant information about previous pregnancies.
04
Indicate the reason for the prenatal genetic analysis, such as maternal age, family history of genetic disorders, or abnormal prenatal screening results.
05
Specify the type of genetic analysis requested, such as carrier screening, chromosomal analysis, or specific gene testing.
06
Include the gestational age at the time of the test request.
07
If known, provide the name and contact information of the healthcare provider who will receive the results.
08
Review the completed form for accuracy and ensure all necessary sections are filled out.
09
Sign and date the requisition form.
10
Submit the completed form to your healthcare provider or the designated laboratory for further processing.

Who needs prenatal genetic analysis requisition?

01
Prenatal genetic analysis requisition is needed by individuals who are
02
Pregnant women who want to understand their baby's risk of having genetic disorders or birth defects.
03
Pregnant women with advanced maternal age (35 years or older) as they are at a higher risk of chromosomal abnormalities.
04
Individuals with a family history of genetic disorders or congenital birth defects.
05
Couples with a previous child or pregnancy affected by a genetic condition.
06
Individuals who have received abnormal results from prenatal screening tests, indicating a potential genetic concern.
07
It is important to consult with a healthcare provider to determine if a prenatal genetic analysis requisition is appropriate in individual cases.
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Prenatal genetic analysis requisition is a request for testing to assess the genetic health of a fetus before birth.
Pregnant individuals or couples seeking to have genetic testing done on their unborn baby.
The requisition form can be filled out by a healthcare provider or genetic counselor and should include relevant medical history and reasons for testing.
The purpose is to screen for genetic disorders or abnormalities in the fetus to better prepare for any potential health issues.
Personal information of the pregnant individual or couple, medical history, reason for testing, and any relevant family history of genetic disorders.
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