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Get Arup Laboratories Patient History Form For Non-invasive Prenatal Testing (nipt) 2017

Unselor Phone Draw Date: Fetal sex by ultrasound: [ ] Male Patient’s current weight Gestational Age at Draw: weeks [ ] Female [ ] Unknown lbs (or) kgs [ ] Ambiguous Patient’s height days inches (or) cm For twin or surrogate/egg donor pregnancies*, check all that apply. We do NOT accept vanished twin, higher order multiple gestation pregnancies, or twins conceived using a surrogate or egg donor. [ ] Ongoing twin pregnancy: [ ] monozygotic [ ] dizygotic [ ] IVF conceived pregn.

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