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INITIAL LABS:
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INITIAL LABS Date:
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BLOOD Type (ABO/Rh):
• • •
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Antibody Screen:
|
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Antibody Comment
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Hgb / Hct:
/
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Hgb ELECTROPHORESIS:
• • •
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HIV Positive?
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RPR Reactive?
|
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Rubella:
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HbsAg Positive?
|
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PAP
• • •
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Gonorrhea Positive?
|
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Chlamydia Positive?
|
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Urine Culture
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TSH:
|
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Cystic Fibrosis Result:
|
Ashkenazi Panel
|
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Other Genetic Screening Test(s):
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Initial Lab Other/Comments
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1st Trimester Screen
|
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1st Trimester Screen Date:
|
1st TM Screen Result
• • •
|
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NIPT
• • •
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2nd Trimester Screen
|
|
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2nd trimester screen date
|
2nd Trimester Screen Result:
• • •
|
|
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2nd TM Screen Comment
|
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24-28 WEEK LABS
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|
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24-28 WEEK LAB DATE
|
50g 1° GTT
|
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Hemoglobin
|
Hematocrit
|
|
HbsAg Positive?
|
RPR Reactive?
|
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HIV Positive?
|
|
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Rhogam
|
RHOGAM DATE
|
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Third Trimester Lab Other/Comments
|
|
|
|
|
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36 Week Cultures
|
Culture Date
|
|
GBS Positive?
|
Gonorrhea Positive?
|
|
Chlamydia Positive?
|
|
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RECORDS FAXED TO L&D
|
|
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Pediatrician
|
Pediatrician Comments
|
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Circumcision
|
PRIVATE CORD BLOOD BANKING
|
