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Version6/20170701REQUEST FORM GENETIC ANALYSIS NONINVASIVE PRENATAL TEST (NIP) Center FOR MEDICAL GENETICS UZ BrusselLaarbeeklaan 101 1090 Brussels secretary laboratory: phone +32 (0)2 477 64 79 fax
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How to fill out request form genetic analysis

01
Start by gathering all the necessary information and documents required for the genetic analysis, such as medical history, family history, and any relevant test results.
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Carefully read and understand the instructions provided with the request form. Pay attention to any specific requirements or guidelines mentioned.
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Fill in your personal details accurately, including your full name, date of birth, contact information, and any other relevant identification details.
04
Provide detailed information about the patient, including their medical history, symptoms, and any specific genetic conditions or tests requested.
05
If applicable, include information about the referring healthcare professional or institution.
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Complete all the sections of the form related to the specific genetic analysis being requested. Provide any additional information or preferences, if necessary.
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Ensure that all the information provided is legible and easily understandable.
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Double-check the completed form for any errors or missing information before submitting it.
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Submit the filled-out request form as per the instructions provided. This may involve mailing it to a specific address or submitting it electronically through a secure portal.
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Retain a copy of the submitted request form for your records, if required.

Who needs request form genetic analysis?

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The request form for genetic analysis is needed by individuals who require genetic testing to diagnose or screen for certain genetic conditions or disorders.
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It is commonly used by patients who suspect that they or their family members may have a genetic predisposition to a particular disease or who want to determine their risk of passing on a genetic condition to their children.
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Healthcare professionals, such as doctors, genetic counselors, or researchers, may also need to complete this form when requesting genetic analysis for their patients as part of their diagnostic or research processes.
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