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Women's Health Referrals
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University Health - Robert B. Green Campus
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Service Requested:
*
Genetics
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Patient will be:
*
Consult Only
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Ultrasound:
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OB
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Level II by MFM Physician
Biophysical Profile
First Trimester Screen
GYN Vaginal
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OB/GYN Clinical History
(Include age, G/P, LMP, and relevant history; if pregnant, include EDC and QUAD/NIPT test results if done)
Reason for visit
*
Please fax all prenatal records, lab and previous ultrasound results. Include a copy of insurance information.
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