Get Nuchal Translucency Exam Data Form (pdf, New Window) - Cdph Ca

This guide provides a step-by-step approach to efficiently complete the Nuchal Translucency Exam Data Form for the California Prenatal Screening Program. Following these instructions will ensure that your submissions are accurate and complete.

Follow the steps to successfully fill out the form.

1. Press the ‘Get Form’ button to access the Nuchal Translucency Exam Data Form in a digital format.
2. Begin by entering the clinician's name, ensuring to follow the specified format of Last, First. Include a contact telephone number for verification purposes.
3. Next, fill out the patient information section by entering the patient’s name and date of birth. Include the test request form number if available.
4. Provide the name of the prenatal care provider in the designated field to identify who is overseeing the patient's care.
5. Complete the Nuchal Translucency Information section, including the NT practitioner credential number and optional site code.
6. Fill in the NT exam date, and note if there is an inability to measure the crown-rump length (CRL) for the fetus.
7. Record the CRL measurement in millimeters. Special attention must be given that CRL values fall between 44.6 mm and 84.5 mm to ensure eligibility for risk assessment.
8. If a twin pregnancy is indicated, answer 'Yes' or 'No.' If there are twins, indicate the chorionicity by checking either monochorionic or dichorionic.
9. Enter the CRL and NT measurements for the second fetus if applicable, ensuring you follow the same format.
10. Review all entered information for accuracy before finalizing the form.
11. Once completed, users can save their changes to the form, download a copy for their records, or print it out for submission.

Complete your forms online confidently and ensure accurate submissions.