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Get ARUP Laboratories Patient History Form For Non-Invasive Prenatal Testing (NIPT) 2019-2024

Ic Counselor Draw date Physician Phone Physician Fax Counselor Phone Gestational age at draw lb / kg Patient s current weight Patient s height Fetal sex by ultrasound: Male Female Ambiguous Unknown weeks days in / cm For twin or surrogate/egg donor pregnancies*, check all that apply We do NOT accept vanished twin, higher order multip.

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