Chromosome Analysis, Fetal

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

KFET

Test Workstation :

KARYO

Specimen Type:

1 cm3 fetal tissue, product of conception, or placental tissue with villi in sterile container with sterile transport media.

Cause for Rejection:

Gross contamination, frozen specimen, or formalin fixed tissue.

Storage:

Refrigerated upon arrival in laboratory.

Availability:

Mon-Fri (0700-1600) Sat (0900-1300)

Methodology:

Culture of fetal cells, harvest, and chromosome analysis with G-banding.

Special Instructions:

Include pertinent medical findings on the requisition with gestational age, suspected diagnosis and/or indication(s) for the testing.

Lab/Phone:

330-543-8483

TAT:

21-42 days

CPT Code:

88233, 88262, 88291, 88380

Synonyms:

Karyotype, Fetal Karyotype, Chromosome Analysis