Alternative contact name: redacted Alternative contact numbers Business: redacted Mobile: redacted Email: redacted (a) Are you a consultant acting on behalf of an Applicant? Yes No (b) If yes, what is the Applicant(s) name that you are acting on behalf of? Insert relevant Applicant(s) name here. (a) Are you a lobbyist acting on behalf of an Applicant? Yes No If yes, are you listed on the Register of Lobbyists? Yes No PART 2 – INFORMATION ABOUT THE PROPOSED MEDICAL SERVICE Application title Non-Invasive Prenatal Testing (NIPT) Provide a succinct description of the medical condition relevant to the proposed service (no more than 150 words – further information will be requested at Part F of the Application Form) The medical conditions relevant to the proposed service are conditions such as Down syndrome, Edward syndrome, Patau syndrome and Turner syndrome that arise where the number of chromosomes present in the patient is abnormal (aneuploidy). Prenatal screening is a routine medical service for a pregnant woman to evaluate her personal risk of fetal aneuploidy. These aneuploidies include but are not limited to; trisomy 21 (Down syndrome), trisomy 18 (Edward syndrome), trisomy 13 (Patau syndrome) and monosomy X (Turner syndrome). This application is for Non-Invasive Prenatal Testing for the detection of fetal aneuploidies to be supported by public funding through the Medicare Benefit Schedule. Provide a succinct description of the proposed medical service (no more than 150 words – further information will be requested at Part 6 of the Application Form) Non-invasive prenatal testing through the analysis of cell free fetal DNA is a major technological advancement in testing for fetal aneuploidy. 1-17
Alternative contact name: redacted Alternative contact numbers Business: redacted Mobile: redacted Email: redacted (a) Are you a consultant acting on behalf of an Applicant? Yes No (b) If yes, what is the Applicant(s) name that you are acting on behalf of? Insert relevant Applicant(s) name here. (a) Are you a lobbyist acting on behalf of an Applicant? Yes No If yes, are you listed on the Register of Lobbyists? Yes No PART 2 – INFORMATION ABOUT THE PROPOSED MEDICAL SERVICE Application title Non-Invasive Prenatal Testing (NIPT) Provide a succinct description of the medical condition relevant to the proposed service (no more than 150 words – further information will be requested at Part F of the Application Form) The medical conditions relevant to the proposed service are conditions such as Down syndrome, Edward syndrome, Patau syndrome and Turner syndrome that arise where the number of chromosomes present in the patient is abnormal (aneuploidy). Prenatal screening is a routine medical service for a pregnant woman to evaluate her personal risk of fetal aneuploidy. These aneuploidies include but are not limited to; trisomy 21 (Down syndrome), trisomy 18 (Edward syndrome), trisomy 13 (Patau syndrome) and monosomy X (Turner syndrome). This application is for Non-Invasive Prenatal Testing for the detection of fetal aneuploidies to be supported by public funding through the Medicare Benefit Schedule. Provide a succinct description of the proposed medical service (no more than 150 words – further information will be requested at Part 6 of the Application Form) Non-invasive prenatal testing through the analysis of cell free fetal DNA is a major technological advancement in testing for fetal aneuploidy. 1-17