Form For Maintenance Of Records By The Genetic Counselling Page 2
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11.
Procedure advised
(i) Ultrasound
(ii) Amniocentesis
(iii) Chorionic villi biopsy
(iv) Foetoscopy
(v) Foetal skin or organ biopsy
(vi) Cordocentesis
(vii) Any other (specify)
12.
Laboratory tests to be carried out
(i)
Chromosomal studies
(ii)
Biochemical studies
(iii)
Molecular studies
(iv)
Preimplantation genetic diagnosis
13.
Result of diagnosis
If abnormal give details.
Normal/Abnormal
14.
Was MTP advised?
15.
Name and address of Genetic Clinic* to which patient is
referred.
16.
Dates of commencement and completion of genetic
counseling.
Name, Signature and Registration No. of the
Medical Geneticist/Gynaecologist/Paediatrician
administering Genetic Counselling.
Place:
Date:
_________________________________________________
1
Strike out whichever is not applicable or necessary
1
Strike out whichever is not applicable or necessary.
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