Forms

Back-up Order Forms

• Back-up Patient Order Form: cfDNA (PDF)
  
• Back-up Patient Order Form: MSAFP (PDF)
  

Translated Prenatal Screening Consent Language

We are providing these translations of the patient consent language on the California Prenatal Screening Program order forms as a courtesy. They should not take the place of your practice’s translation or interpretation services necessary to ensure appropriate consent. Please feel free to share the translated consent language with patients, but ask them to sign the English language Consent and Order Confirmation or Back-up Patient Order Form.

• Patient Consent Language in Spanish (PDF)
  
• Patient Consent Language in Chinese (PDF)
  
• Patient Consent Language in Korean (PDF)
  
• Patient Consent Language in Vietnamese (PDF)
• Patient Consent Language in Tagalog (PDF)
  

Decline Forms

• Patient Decline Form: cfDNA (English, PDF) 
• Patient Decline Form: cfDNA (Spanish, PDF)
  
• Patient Decline Form: MSAFP (English, PDF)
  
• Patient Decline Form: MSAFP (Spanish, PDF) 
  

Provider Handbook

• Provider Handbook (PDF)
  
• Provider Handbook Appendices:
  

• Appendix A: Chromosomal or Structural Anomalies Detected (PDF)
  
• Appendix B: Prevention of Neural Tube Defects (PDF)
  
• Appendix C: Ultrasound Dating and Down Syndrome Screening (PDF)
  
• Appendix D: Mid-trimester Risk for Chromosome Abnormalities by Maternal Age at Term (PDF)
  
• Appendix E: cfDNA Order Patient & Blood Draw Instructions (PDF)
  
• Appendix F: MSAFP Order Patient & Blood Draw Instructions (PDF)
  
• Appendix G: cfDNA Back-up Consent & Order Form (PDF)
  
• Appendix H: MSAFP Back-up Consent & Order Form (PDF)
  
• Appendix I: cfDNA Patient Decline Form (PDF)
  
• Appendix J: MSAFP Patient Decline Form (PDF)
  
• Appendix K: Consent & cfDNA Order Confirmation Sample (PDF)
  
• Appendix L: Consent & MSAFP Order Confirmation Sample (PDF)
  

cfDNA Laboratory Instructions

• cfDNA Laboratory Instructions: Natera (PDF)
  
• cfDNA Laboratory Additional Information: Natera (PDF)
  
• cfDNA Laboratory Instructions: Quest Diagnostics (PDF)
  
• cfDNA Laboratory Additional Information: Quest Diagnostics (PDF)
  

Patient Materials

• Education Resources - For Patients
• Genetic Support Foundation Videos
• Prenatal Screening Patient Booklet (English, PDF, 12 pages) ... (Spanish, PDF, 12 pages) ... (Chinese, PDF, 12 pages)
• Patient Booklet Summary (English, PDF, 2 pages) ... (Spanish, PDF, 2 pages) ... (Chinese, PDF, 2 pages)
• Prenatal Screening Patient Booklet (use "select language" button in top right of web page to view in additional languages)
• Patient FAQ
• Prenatal Screening Patient Video (English, MP4, 3.29 min) ... (Spanish, MP4, 4.14 min) ... (Chinese, MP4, 3.59 min)
• Sexual Orientation and Gender Identity (SOGI) Information Survey

• QR code for Patient Video in English (save and share with patients to use with a QR Code Reader) 
• QR code for Patient Video in Spanish (save and share with patients to use with a QR Code Reader)
• QR code for Patient Video in Chinese (save and share with patients to use with a QR Code Reader)

To download, distribute, or share a PNS Program patient video file, please follow a link to the vimeo site and download each video separately.

• English
  
• Spanish 
• Chinese

Other

• Outcome of Pregnancy Letter (PDF)
  
• Cell-free DNA Screening Predictive Value Calculator
• Prenatal Diagnosis Centers by County (PDF)