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NT/CRL Data Form

Thank you for choosing Mayo Medical Laboratories.

All sonographers within the organization must complete this form separately.

Prior to submitting this form, a copy of the certification card must be faxed to 507.538.7709.

Mayo Medical Laboratories only accepts nuchal translucency (NT) measurements from certified sonographers.

Questions can be directed to Mayo Medical Laboratories: 800.533.1710
Ask for the maternal screening area.

All Fields Are Required

Primary Client Information

If the sonographer is completing this form, contact your laboratory for the following information.

All fields are required.
Account Name  
Mayo Medical Laboratories Account Number (C#)  
Contact  
Address   
  
Phone Number  
Sonographer QC data will be provided on a regular basis.
Please select one of the following:
Client agrees to distribute QC data to the sonographer.
Client Email  
Please send QC data directly to the sonographer
Sonographer Information
Complete the following for each sonographer performing NTs for screening.
Sonographer Last Name  
Sonographer First Name  
Certifying Agency
NTQR/DMSTAT
FMF
FASTER
Certification Number  
Sonographer Phone  
Sonographer Email  
Expected Number of NTs/Month for Maternal Screening  
Sonographer's Supervisor  
Supervisor's Phone Number  
Supervisor's Email  
Does the Sonographer Provide NT Services for Other Institutions? Yes No
Sonographer Data
Please supply the matched NT/CRL measurements. Sonographers should provide paired NT/CRL measurements from as many pregnancies as possible to validate the appropriate reference data.

How would you like to submit this data?
Attach a spreadsheet.

Enter data manually.