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PRENATAL and PREGNANCY LOSS Test Request Form
Acetylcholinesterase GA 23 weeks or greater p AFAFP amniotic fluid alpha fetoprotein GA 22 weeks 6 days or less p CMV - PCR cytomegalovirus p Parvovirus - PCR p Toxoplasma - PCR 7. Reglab. org/billingcompliance/participating-insurance-plans/ RESULT REPORTING ORDERING PROVIDER Name signature Email H. PRENATAL p PREGNANCY LOSS Products of conception POC Amniotic fluid Chorionic villus sampling CVS Fetal fluid source p Fetal tissue source p Villi p Paraffin-embedded tissue confirmed fetal tissue...
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