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(iv) Mental rota idat on (v) Hacmoglcbinopathy (vi) Sex linked disorders (vii) Any other (specify) B. Advanced maternal age (—35 yeEib) C. Mother/father/sibling has genetic disease (specify) D. Others (specify) Procedure advised* (0 Ultrasound CO Amniocentesis (iii) Chorionic VilH biopsy (iv) Fouioscopy (v) Fectal skin or organ biopsy (vi) Cordocentesis (vii) Any other (specify) Laboratory tests to be carried out (i) Chromosomal studies (ii) Biochemical studies (iii) Molecular studies Result of prenatal diagnosis: Normal/Abnormal If abnormal give details. Was MTP advised? Name and address of Genetic Clinic* to which patient referred. Dates of commencement and comp!ct:on of genetic counselling. Name, Signature and Registration No. of the Medical Geneticist/Gynaecologist/ Paediatrician. Date •Strike out whichever is not applicable or not necessary. Form E [See rule 9 (3)] NAME, ADDRESS AND REGISTRATION NO. OF GENETIC LABORATORY RECORD TO BE MAINTAINED BY THE GENETIC LABORATORY