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 English (PDF, 1.3MB)​
  
• Patient Consent Language in Chinese (PDF, 24.4MB)
  
• 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 Addendum for Sex Chromosome Aneuploidies​
  
• 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 Labora​tory Instructions and FAQs

​Natera

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

Quest

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

Revvity

• cfDNA Laboratory Instructions: Revvity (PDF)
  
• cfDNA Laboratory Additional Information: Revvity (PDF)​
  

Prenatal Diagnosis Center Standards

​Prenatal Diagnosis Center (PDC) Standards and Definitions 2022 (PDF)​​

Patient Materials

All Education Resources for Patients

Genetic Support Foundation Videos

​PNS Patient Booklet

Prenatal Screening Patient Booklet - English (PDF, 1.3MB)

• Armenian (PDF)
• Chinese, Simplified (PDF, 24.4MB)​
• Farsi (PDF)
  
• Russian (PDF) 
  
• Korean (PDF)
• Spanish (PDF)​
• Tagalog (PDF)
• Vietnamese (PDF)
  
• Hmong (PDF)
• Punjabi (PDF)​​

Prenatal Screening Patient Booklet X and Y Insert - English (PDF, 2 pages)

• Chinese, Simplified (PDF)
  
• Korean (PDF)
  
• Spanish (PDF)
  
• Tagalog (PDF)
  
• ​Vietnamese (PDF)
  

Patient Booklet Summaries - These summaries should be used in addition to the patient booklets, not instead of them. It is important that each patient receive the patient booklet. The patient booklet includes a full description of the program and its components, what consent means, and mandated legal notices.

• ​English (PDF)
  
• Armenian (PDF)
  
• Chinese, Simplified (PDF)
  
• Farsi (PDF)
• Hmong (PDF)​​
  
• Korean (PDF)
  
• Punjabi (​PDF)
• Russian (PDF)​​
  
• Spanish (PDF)
  
• Tagalog (PDF)
  
• Vietnamese (PDF)
  

Prenatal Screening Patient Glossary - English (PDF, 2 pages) ​​​​​

Prenatal Screening Patient Booklet (use “sel​ect language” button in top right of web page to view in additional languages)

Screen Positive Booklets

• ​Trisomy 21 (Down Syndrome) (PDF)
  
• ​Spanish (PDF)
  
• Simplified Chinese (PDF)
  
• Trisomy 18 (PDF)
  • Spanish (PDF)
    
  • Simplified Chinese (PDF)
    
• Trisomy 13 (PDF)
  • Spanish (PDF)
    
  • Simplified Chinese (PDF)
    
• Neural Tube Defects (PDF)
  • Spanish (PDF)
    
  • Simplified Chinese (PDF)
    
• Turner Syndrome (PDF)
  • Spanish (PDF)
    
  • Simplified Chinese (PDF)
    
• ​XYY (PDF)
  • Spanish (PDF)
    
  • Simplified Chinese (PDF)
    
• Trisomy X (PDF)
  • Spanish (PDF)
    
  • Simplified Chinese (PDF)
    
• Klinefelter Syndrome (PDF)​
  • Spanish (PDF)
    
  • Simplified Chinese (PDF)​
    

Other Materials

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
  

Letters

• Outcome of Pregnancy Letter (PDF)
  
• Prenatal Insurer Letter (PDF)
  
• Prenatal Provider Letter (PDF)​
  
• Genetic Counselor ​​Letter (PDF)​
  

Program Resources

• CalGenetic Portal
• CalGenetic Portal Resources
• Education Resources - For Patients
• Education Resources - For Providers
  
• Order Supplies Online
• Newborn Screening
  
• ​​Patient FAQ
  
• Provider FAQ
• Sexual Orientation and Gender Identity (SOGI) information survey
• Sharing an Abnormal Prenatal Screening Result with a Patient​​
• Webin​ars
• Cell-free DNA Screening Predictive Value Calcula​tor
• Prenatal Diagnosis Centers (PDC) by C​ounty​
  

Newsletters

• Prenatal Information and Update Newsletter
• ​Summer 2022 (PDF)​
  
• Winter 2022 (PDF)
  
• Fall 2021 (PDF)
  
• Summer 2020 (PDF)
• Fall 2019 (PDF)
• Fall 2018 (PDF)