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Fax:Dartmouth Hitchcock Clinics(603) 6401909Referring Provider: ___ Office Phone: ___ Practice Name: ___ Fax: ___ Practice Address ___PCP Name: ___ Patient Name: ___ MRN# ___ DOB: ___ Cell Phone ___
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How to fill out maternal-fetal-medicine-and-prenatal-diagnosis-program

01
Gather necessary personal information: Include your name, date of birth, and contact information.
02
Provide medical history: Fill in details about your previous pregnancies, any complications, and your family medical history.
03
Complete prenatal care details: Include information about your current obstetrician or healthcare provider.
04
Note current medications: List any medications or supplements you are currently taking.
05
Fill out risk factors: Indicate any potential risk factors such as age, weight, and existing health conditions.
06
Attach relevant documents: Include ultrasound results, genetic testing information, and any other supportive medical documents.
07
Review the application: Double-check all entries for accuracy and completeness.
08
Submit the application: Send the completed application to the appropriate maternal-fetal medicine program.

Who needs maternal-fetal-medicine-and-prenatal-diagnosis-program?

01
Women experiencing high-risk pregnancies.
02
Expectant mothers with pre-existing health conditions.
03
Women with a family history of genetic disorders.
04
Expectant mothers over the age of 35.
05
Women who have had previous pregnancy complications.
06
Individuals seeking genetic counseling or testing.
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The maternal-fetal medicine and prenatal diagnosis program is a specialized medical program focused on the health and management of high-risk pregnancies, including advanced diagnostic procedures to monitor fetal development.
Healthcare providers and institutions that offer maternal-fetal medicine services and prenatal diagnostic testing are typically required to file under this program.
To fill out the maternal-fetal medicine and prenatal diagnosis program, providers must complete specified forms detailing patient information, diagnostic procedures performed, and outcomes, ensuring accuracy and compliance with regulatory requirements.
The purpose of this program is to enhance the care of pregnant individuals by identifying potential risks, facilitating timely interventions, and improving overall maternal and fetal health outcomes.
Providers must report patient demographics, medical history, diagnostic tests conducted, findings, treatment provided, and any complications encountered during the pregnancy.
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