Get the free Medical Genetics Prenatal Referral Form

800 Commissioners Rd East PO Box 5010 London ON N6A 5W9 Tel (519) 685-8140 Fax (519) 685-8214 Medical Genetics Prenatal Referral Form IMPORTANT: TO ENSURE TIMELY PROCESSING PLEASE FAX COMPLETED REFERRAL

How to fill out medical genetics prenatal referral

How to fill out a medical genetics prenatal referral:

1. Begin by gathering necessary information such as the patient's personal details, including their full name, date of birth, and contact information.
2. Next, provide a detailed medical history of the patient, including any previous pregnancies, medical conditions, previous genetic testing, or known genetic disorders in the family.
3. Include information about the current pregnancy, such as the estimated due date, the number of fetuses, and any complications or abnormalities identified in prenatal screening.
4. Specify the reason for the referral, whether it is due to advanced maternal age, a family history of genetic disorders, abnormal prenatal screening results, or other concerns.
5. Provide detailed information about the referring healthcare provider, including their name, contact information, and any relevant credentials.
6. Include any additional documents or reports that may be relevant to the referral, such as ultrasound images, lab results, or genetic testing reports.

Who needs medical genetics prenatal referral:

1. Pregnant women over the age of 35: Advanced maternal age is associated with an increased risk of chromosomal abnormalities such as Down syndrome. A medical genetics prenatal referral is often recommended to assess the risk and offer appropriate testing options.
2. Couples with a family history of genetic disorders: If there is a known genetic disorder in the family, such as cystic fibrosis or sickle cell disease, a medical genetics prenatal referral can help determine the risk of the condition being passed on to the baby and provide options for genetic testing or counseling.
3. Individuals with abnormal prenatal screening results: If the results of prenatal screening tests, such as the first trimester screening or the cell-free DNA test, indicate an increased risk of a genetic condition, a medical genetics referral is necessary to confirm the diagnosis and provide appropriate guidance and support.
4. Couples who have experienced recurrent pregnancy loss or stillbirth: If a couple has a history of recurrent pregnancy loss or stillbirth, a medical genetics prenatal referral can help investigate potential underlying genetic factors that may be contributing to the losses and provide guidance for future pregnancies.
5. Those with concerns about fetal anomalies or developmental delays: If there are concerns about fetal anomalies identified on ultrasound or if a baby has significant developmental delays, a medical genetics prenatal referral can help diagnose any underlying genetic conditions and provide appropriate management and support for the baby and their family.

For pdfFiller’s FAQs

What is medical genetics prenatal referral?

Medical genetics prenatal referral is a process in which healthcare providers refer pregnant individuals to genetic counselors or specialists for evaluation and counseling regarding genetic testing and potential risks during pregnancy.

Who is required to file medical genetics prenatal referral?

Healthcare providers, such as obstetricians, genetic counselors, or midwives, are required to file medical genetics prenatal referral when they believe there may be genetic concerns or risks during the pregnancy.

How to fill out medical genetics prenatal referral?

Medical genetics prenatal referral can be filled out by providing the pregnant individual's medical history, family history of genetic conditions, any previous pregnancy complications, and reasons for referral. It should also include any relevant test results or screenings.

What is the purpose of medical genetics prenatal referral?

The purpose of medical genetics prenatal referral is to identify potential genetic risks or conditions that may affect the pregnancy or the baby, and to provide guidance and counseling to the pregnant individual and their family.

What information must be reported on medical genetics prenatal referral?

The medical genetics prenatal referral should include the pregnant individual's personal and family medical history, any previous pregnancy complications, reasons for referral, relevant test results, and any concerns or questions related to genetic risks.

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