|
Initial Labs (DATE):
|
Blood Type
• • •
|
|
RH POS?
|
ANTIBODY SCREEN POS?
|
|
CBC: HGB
|
CBC: HCT
|
|
VDRL REACTIVE?
|
VARICELLA IMMUNE?
|
|
RPR POS?
|
RUBELLA IMMUNE?
|
|
Urine Culture/Screen
• • •
|
HBsAg: POS?
|
|
Chlamydia POS?
|
Hepatitis C POS?
|
|
Gonorrhea POS?
|
HIV POS?
|
|
Herpes POS?
|
|
|
Pap TEST
• • •
|
Date
|
|
Tay-Sachs(jew, Cajun, Cana)
|
Date
|
|
Familial Dysautonomia (Jew)
|
Date
|
|
Cystic Fibrosis
|
Date
|
|
8-20 WEEK LABS
|
|
|
1st Trimester Aneuploidy
|
Date
|
|
MSAFP/MULTIPLE MARKERS
• • •
|
Date
|
|
2ND TRIMESTER SERUM SCREENING
|
Date
|
|
AMNIOCENTESIS/CVS (DATE):
|
|
|
KARYOTYPE
|
Date
|
|
Amniotic Fluid (AFP)
|
Date
|
|
Anti-D Immune Globulin (RHIG)
|
Date
|
|
|
|
|
24-28 Week Labs (DATE):
|
24-28 Week 1 HR GLUCOSE
|
|
24-28 Week HGB
|
24-28 Week HCT
|
|
GTT DATE:
|
GTT (FBS):
|
|
GTT (1 HOUR):
|
GTT (2 HOUR):
|
|
GTT (3 HOUR):
|
|
|
ANTI-D IMMUNE (RhIG) GIVEN:
|
Date
|
|
|
Signature
• • •
|
|
Hgb A1C and EAG
|
Date
|
|
|
|
|
32-36 Week Labs (DATE):
|
GBS POS?
|
|
HGB
|
HCT:
|
|
HIV 36 week
|
Date
|
|
VDRL 36 wk
|
Date
|
|
CHLAMYDIA 36 wk
|
Date
|
|
GONORRHEA 36 wk
|
Date
|
|
Comments:
|
Date
|
