Private Pay Laboratory Requisition - Panorama NIPT 2026

1. Click ‘Get Form’ to open the Private Pay Laboratory Requisition - Panorama NIPT in the editor.
2. Begin by entering the Patient Name, Address, Telephone Number, Date of Birth, and Email. Ensure accuracy as this information is crucial for identification.
3. Fill in the billing details by selecting whether the bill is to be sent to the Patient or Doctor. Include Doctor's Name, MSC #, Address, Fax Number, Organization, Telephone Number, and Email.
4. Indicate Gestational Age in weeks and Due Date. Provide Maternal Weight in kg and answer questions regarding twin/multiple gestation and egg donor status.
5. Select clinical indications for testing from the provided options. This helps in determining the necessity of the test based on medical history.
6. Choose the desired Panorama Prenatal Test option and indicate if you want to know the baby’s gender. If applicable, provide details for a father’s cheek swab sample.
7. Review all entered information for accuracy before signing. Ensure both patient and father (if applicable) sign where indicated.

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