Micromanipulation record - RGI

Patient name*

DOB

Disease*

Testing Requested:*

Cycle#*

Date of Aspiration

ICSI performed*

IVF Center:

Biopsy Performed by

Biopsy Performed date

Biopsies*

Batching @ RGI*

Re-biopsy:*

If using another labeling system please specify here:

please complete all of the above

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*

Embryo#*

Day 5/6 Embryo Grade

Indicate how many cells removed

NGS/PCR*

ET / CRYO / DISC*