Loading
Form preview picture

Get Harmony Test Form

Required Test Information Harmony Prenatal Test with Y Analysis Singletons only Gestational Age Draw Date weeks days Is this a redraw Measured on Yes No Patient s Birthdate by U/S LMP IVF LMP Date of Fetuses IVF Pregnancy Egg Donor is Self Non-self Age at retrieval years 888. Place the PAT barcode label here Ordering Lab Specimen ID Patient Information Clinic Information First Name Clinic Name Last Name Ordering Clinician Street Address City Province Country Postal Code Phone Fax Female Male Health Insurance Number Gender Weight kg Height cm Patient Consent I hereby authorize Dynacare or its designate to collect a biological specimen from me or from an individual for whom I have the legal right to authorize the collection and testing of a specimen. I further authorize Dynacare or its designate to perform testing on that specimen. I have received sufficient information about the Harmony Prenatal Test and have received satisfactory answers to my questions. I understand that therapeutic decisions should not be based solely on the results of prenatal screening. I understand that my sample will be sent to a laboratory in the United States for testing. I understand that personal information including but not limited to name and date of birth will accompany the sample. Personal information held in countries outside of Canada could be subject to disclosure to government or other authorities whether of that country or of another country. Year Month Day Patient Signature Clinician Signature I attest that this patient has been informed about details of the test and its capabilities and limitations and has given consent for this test. 988. 1888 3885 boul* Industriel Laval QC Canada H7L 4S3 F 450. 663. 4428 TP-00056-F9 Rev 1. 0 Effective Date 11/19/2013. I understand that therapeutic decisions should not be based solely on the results of prenatal screening. I understand that my sample will be sent to a laboratory in the United States for testing. I understand that personal information including but not limited to name and date of birth will accompany the sample. I understand that my sample will be sent to a laboratory in the United States for testing. I understand that personal information including but not limited to name and date of birth will accompany the sample. Personal information held in countries outside of Canada could be subject to disclosure to government or other authorities whether of that country or of another country. Personal information held in countries outside of Canada could be subject to disclosure to government or other authorities whether of that country or of another country. Year Month Day Patient Signature Clinician Signature I attest that this patient has been informed about details of the test and its capabilities and limitations and has given consent for this test. I understand that therapeutic decisions should not be based solely on the results of prenatal screening. I understand that my sample will be sent to a laboratory in the United States for testing. I understand that personal information including but not limited to name and date of birth will accompany the sample. Personal information held in countries outside of Canada could be subject to disclosure to government or other authorities whether of that country or of another country.

How It Works

teste harmony rating
4.8Satisfied
47 votes

Tips on how to fill out, edit and sign Singletons online

How to fill out and sign Gestational online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Are you searching for a quick and efficient solution to fill out Harmony Test Form at an affordable price? Our platform will provide you with a rich variety of templates that are available for filling out on the internet. It only takes a few minutes.

Follow these simple actions to get Harmony Test Form ready for sending:

  1. Select the form you want in the collection of legal forms.
  2. Open the form in the online editor.
  3. Look through the recommendations to determine which info you need to include.
  4. Select the fillable fields and add the required info.
  5. Put the relevant date and place your e-signature as soon as you complete all of the fields.
  6. Check the document for misprints as well as other mistakes. In case there?s a necessity to change something, the online editor and its wide variety of instruments are at your disposal.
  7. Save the completed template to your gadget by clicking Done.
  8. Send the e-form to the intended recipient.

Filling in Harmony Test Form doesn?t really have to be perplexing anymore. From now on comfortably get through it from your home or at the office from your smartphone or desktop.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Nipt test report sample FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to Harmony Test Form

  • TP-00056-F9
  • Birthdate
  • Boul
  • industriel
  • qc
  • Barcode
  • Laval
  • h7l
  • Singletons
  • XY
  • clinician
  • gestational
  • redraw
  • fetuses
  • Kg
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.