Amendment status not verified — confirm the current text below against the official source.
Patient's name , Age Husband's/Father's name Full address with Tel. No., if any Referred by/sample sent by (full name and address of Genetic Clinic (Referral note to be preserved care- fully with case paper). Type of samplo : Maternal blood/Chorionic villus sample/amniotlc fluid/Foetal blood or other foetal tissue (Specify) 29