NON INVASIVE PRENATAL TESTING Doctor’s Information Clinical use: PathWest offer Non-Invasive Prenatal Testing to women who are at high risk (>1:300) of carrying an aneuploidy fetus as a result of a first or second trimester antenatal screen. The Harmony Prenatal Test can be ordered by a healthcare professional for women with pregnancies of at least 10 weeks’ gestational age. The Harmony test is available for any singleton or twin pregnancy, including those conceived by IVF. PLEASE NOTE: THE STRINGENT DOCUMENTATION AND COLLECTION REQUIREMENTS FOR THIS TEST ARE SET OUT BELOW. BOTH HARMONY AND PATHWEST REQUEST FORMS MUST BE COMPLETED. Special Conditions: A patient MUST receive counselling by their doctor on the benefits and limitations of the test. 1. Both Patient & Doctor MUST sign the consent section of the Ariosa Harmony request form. The Doctor must tick what test is required in the Test Information section (e.g. if Y or X&Y analysis is required). This form needs completing prior to the patient attending PathWest. Ariosa will not accept the sample for testing without the form completed correctly. The Harmony & Pathwest request forms need to be completed by you prior to patient’s arrival at collection centre PLEASE NOTE: Patient height, weight, fetal gestational age, plus how it was determined, the number of fetuses and whether the pregnancy was IVF, is all essential information and must be completed. 2. Specimens for this test can be collected at various metro Pathwest collection sites on a Monday. Bookings are essential. Please advise patient to contact their closest collection site for an appointment time. This information is provided on the patient information form. Where Monday is a public holiday tests will be performed on Tuesdays. Please Note: Until the 4th of May 2015 the NIPT test will only be collected on a MONDAY. After the 4th of May 2015, collections will be available on MONDAY, TUESDAY and WEDNESDAY. 3. Payment of $420 is required prior to collection by credit card – Visa or MasterCard only. 4. In some cases the test may not produce results and a re-bleed is required along with ANOTHER SIGNED request form from Doctor and Patient. The testing will be done by Ariosa at no further cost to the patient. If no result is produced from the re-bleed, monies will be refunded. Please be aware that increased maternal weight and/or early gestational age may cause low fetal DNA levels and no result can be provided. 5. Turnaround time for a result is up to 14 days. If you have not received your results by fax, Please contact the Diagnostic Genomics Duty Scientist on 0424 136 317 or via email at diagnosticgenomicsqeii@health.wa.gov.au For further assistance, contact Dr Karen Carpenter on 6383 4228 Information on this test is available from http://www.ariosadx.com/ Disclaimer: All care is taken when collecting and transporting the specimen, however PathWest is not responsible for transportation strikes or delays, or public holidays causing delays of collection either in WA or the USA. This test is not performed by PathWest. It is sent away to Ariosa in California USA. Ariosa refer to NIPT as the ‘Harmony’ test. V1.0 Issued 06/05/2015 PathWest Marketing
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