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This is a sendout test. Please note that turnaround time is defined as the anticipated time from set up day to results release.
S51559: First Trimester Screening, hCG [16145] Print View
Interpretation      
Age Risk Down Syndrome      
MSS Down Syndrome Risk      
Risk for Trisomy 18      
Calculated Gestational Age      
PAPP-A     ng/mL 
PAPP-A MoM      
hCG     IU/mL 
hCG MoM      
NT MoM      
Date of Birth      
Collection Date      
Maternal Weight     lbs 
Est'd Date of Delivery      
EDD Determined by      
Mother's Ethnic Origin      
Number of Fetuses      
Insulin-Dependent Diabetic      
Repeat Specimen      
HX of Neural Tube Defects      
Brief History (NTD)      
History of Down Syndrome      
Donor Egg      
Donor Age: Egg Retrieval      
Ultrasound Date      
Ultrasonographer's Name      
NTQR-Ultrasonographer ID#      
NTQR Location ID#      
NTQR Reading Phys ID#      
FMF-Ultrasonographer ID#      
Crown Rump Length     mm 
Nuchal Translucency     mm 
Nasal Bone      
If twins      
Twin B CRL     mm 
Twin B NT     mm 
Twin B Nasal Bone      

PRIMARY
1 Serum 2 (1.2) mL   Frozen - 60 Day(s)/Refrigerated - 4 Day(s)/Room Temperature - 48 Hour(s)  
ALTERNATE

Collect sample between 10 3/7 weeks to 13 6/7 weeks gestation. This
test cannot be performed unless all demographic data and test data
are provided by the ordering physician.


The following information is required for this test:
----------------------------------------------------
Date of Birth:__/__/__ Collection Date:__/__/__
Maternal Weight:__LBS

Estimated Date of Delivery (EDD):__/__/__ determined by: __ Ultrasound
__Last Menstrual Period (LMP), __Physical Exam

Mother's Ethnic Origin: __African American, __Asian, __Caucasian,
__Hispanic, __Other

Number of Fetuses: __One _Two __More than 2
How many fetuses?___________

_Yes_No Patient is an insulin-dependent diabetic prior to pregnancy
_Yes_No This is a repeat specimen for this pregnancy
(Repeat testing following a screen positive result for
Down Syndrome or Trisomy 18 is NOT recommended)
_Yes_No History of neural tube defect If yes explain:____________
_Yes_No History of Down syndrome If yes explain:____________
_Yes_No Pregnancy is from a donor egg Age or DOB of Donor:_______
Other Relevant Clinical information:________________________________

Ultrasound date:__/__/__ Ultrasonographer's name____________________
Nuchal Translucency Measurement Credentialing Agency (required, check
one box)
__NTQR Ultrasonographer's ID#_________ Location ID#__________
__FMF Ultrasonographer's ID#_________ Other (List)__________ ID#___

Crown Rump Length (CRL)_____mm Nuchal translucency (NT)_____mm
EDD from CRL __/__/__

If twin gestation, are the twins Dichorionic, Monochorionic Twin B
CRL____mm, Twin B NT____mm
Setup Schedule
Monday-Saturday

Reported (Analytical Time)
Next day

CPT Codes
84163,84702

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Notes
METHODOLOGY: Calculation, Immunoassay CPT Codes: 84163,84702 Test is available for all clients outside of California.






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