Get Unmc Prenatal And Pregnancy Loss Microarray Test Request Form 2020-2025

Filling out the UNMC Prenatal And Pregnancy Loss Microarray Test Request Form online is an essential step in ensuring accurate testing and timely results. This guide provides clear, step-by-step instructions to help users navigate each section of the form with confidence.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering patient identification information in Section A. This includes the patient's name, date of birth (DOB), and phone number.
3. Continue to the pregnancy information in Section B. Indicate whether the pregnancy was a result of egg donation, the type of gestation (e.g., twin), and specify the gestational age and fetal sex if known.
4. Document whether the patient wishes to know the fetal sex and provide information on any previous prenatal serum screening.
5. Fill out the specimen details, including collection date and time, as well as patient consent regarding specimen storage.
6. In Section D, indicate the specimen type and select the tests that are required. Make sure to check all applicable options for prenatal and pregnancy loss.
7. If applicable, fill in any clinical information in Section E, including other indications or family history relevant to the tests ordered.
8. Complete the billing information in Section F, specifying whether the billing will be made through insurance, client billing, or patient self-pay. Ensure to include any necessary insurance details and ICD codes.
9. Record the ordering provider's information in Section G, ensuring the name and facility are complete along with the required contact details.
10. Finally, confirm if any additional reports need to be sent and provide the necessary shipping information. After reviewing your entries for accuracy, save your changes, and proceed to download or print the completed form.

Take the next step and complete your document online for efficient submission.