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(Referral note with indications and case papers of the patient to be preserved with form F) (Self-referral does not mean a client coming to a clinic and requesting for the test or the relative/s requesting for the test of a pregnant women)
I, _________________________________ (name of the person conducting ultrasonography/image scanning) declare that while conducting ultrasonography/image scanning on Ms.____________________ (name of the pregnant woman), I have neither detected nor disclosed the sex of her foetus to any body in any manner.
FORM F [See Proviso to Section 4(3), Rule 9(4) and Rule 10(1A)] FORM FOR MAINTENANCE OF RECORD IN RESPECT OF PREGNANT WOMAN BY GENETIC CLINIC/ULTRASOUND CLINIC/IMAGING CENTRE 1. Name and address of the Genetic Clinic/Ultrasound Clinic/Imaging Centre. 2. Registration No. 3. Patient’s name and her age 4. Number of children with sex of each child 5.
FORM – F [See proviso to Section 4(3), rule 9(4) and rule 10(1A)] (New amended on 4th February, 2014 notified on 31st January 2014) FORM FOR MAINTENANCE OF RECORD IN CASE OF PRENATAL DIAGNOSTIC TEST / PROCEDURE BY GENETIC CLINIC / ULTRASOUND CLINIC / IMAGING CENTRE SECTION A: To be filled in for all Diagnostic Procedures/Tests 1.
IMPORTANT INSTRUCTIONS: (1) Click Here to view Model 'F' Form. (2) Monthly reports has been made operational since 1 September 2013. (3) Form 'F' can be submitted online up to five calendar days from the date of procedure. (4) We have implemented feature to 'Review' forms before actual submission.
Model “F” Form. [From F] [See proviso to section 4(3), rule 10(1-a)] FORM FOR MAINTENANCE OF RECORD IN CASE OF PRENATAL. DIAGNOSTIC TEST/PROCEDURE BY GENETIC CLINIC/ULTRASOUND. CLINIC/IMAGING CENTER. Section A: To be filled in for all Diagnostic Procedures/Tests.
Created Date: 5/14/2014 6:39:16 AM
In the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Rules, I )96, for Form F, the following Form shall be substituted: [See Proviso to Section 4(3), rule 9(4) and rule IO(IA)]
Forms and Formats under PCPNDT Act: Form A; Form B ; Form C ; Form D ; Form E ; Form F ; Form G; Form H
FORM- F. [See Proviso to Section 4(3), rule 9(4) and rule 10(1A)] (New amended on 4th February, 2014 notified on 31st January, 2014) FORM FOR MAINTENANCE OF RECORD IN CASE OF PRENATAL DIAGNOSTIC TEST/ PROCEDURE BY GENETIC CLINIC / ULTRASOUND CLINIC / IMAGING CENTRE.
