Get Postnatal Cytogenetic Test - Referral Form - Pathology Imperial Nhs

Filling out the POSTNATAL CYTOGENETIC TEST - REFERRAL FORM online is a crucial step in ensuring proper genetic testing for individuals after birth. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form online:

1. Press the ‘Get Form’ button to access the referral form, allowing you to fill it out in your preferred browser or document editor.
2. Begin by providing the patient's personal details. Complete the fields for the surname, forename, address, date of birth, and sex, selecting 'Male' or 'Female' as appropriate.
3. Fill in the NHS number, hospital name, department, postcode, and the full surname of the consultant responsible for the case.
4. Enter the GP details, including whether the referral is from an NHS or private source, and if the patient has a high risk of infectious disease, note this with a 'Y' or 'N'. If the answer is 'Y', specify the risk to ensure the sample is processed appropriately.
5. In the 'TEST DETAILS' section, provide a clear reason for the request or clinical indication for the test. Specify the type of test required, whether it is Karyotype/FISH or Array CGH analysis, and indicate if it is urgent or routine.
6. Include information regarding the blood type to be collected (important for both pediatric and adult samples) and the amounts needed.
7. Document the date and time the sample was taken, as accurately recording this information is essential for processing.
8. Review the consent statement, ensuring that the referring clinician is aware that the purpose of the test has been clearly communicated to the patient or their carer. The clinician should then provide their signature in the indicated area.
9. Finally, once all sections are completed, save your changes, and make sure to download, print, or share the form as necessary.

Complete your POSTNATAL CYTOGENETIC TEST referral form online today!