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 Hospital based Programs and Clinics

If you have considered adding Genetic Counseling to your hospital based programs in Oncology, Breast Cancer, Cardiology, Neurology or other areas of adult medicine,  Genetic Counseling Services offers you the framework to begin doing so.  

Patients who complete our Initial Assessment often request further face-to-face genetic counseling at a center that provides access to physicians and services which may accompany their increased risk status.  Contracting with Genetic Counseling Services, on a capped monthy basis, or per your customized requests, allows you to capture a steady stream of referrals of patients who are investigating their susceptibility to a number of conditions.   

Your patients who contact us after we have established a contractual relationship with your clinic or hospital are readily offered genetic counseling by telephone.   Patients in your geographic area who access our service otherwise are offered the options of insurance-pay, self-pay or clinic-pay, with the recommendation to contact your center should they wish to opt for the clinic pay option.   We will help you to design a system of collaboration with our service, suggesting that a point person or navigator at your Center be identified to assist in coordinating the flow of information between Genetic Counseling Services and your Institution.  

The following organizations, guidelines or position statements support the role of genetic counseling in program/clinic accreditation:

National Accreditation Program for Breast Centers

Colorectal Recommendations/Center for Disease Control

American College of Surgeons

Re: Cardiac

Heart Rhythm Society

Supportive Statements of Other Organizations

Please Call Us at (518)-370-4363  or (888)-260-6543  or submit your questions below.  

1. Name

1. Name
2. What is your relationship to the individual with hearing loss?

2. What is your relationship to the individual with hearing loss?

You may want to check with others to obtain more information to complete this form.  The more we know, the better we are able to verify the best genetic testing for your concern.  
3. How old is the affected and how are they doing now?

3. How old is the affected and how are they doing now?

Describe the situation. Is this a manageable condition?  Are there significant health issues and are they being managed? 
4. When was onset of hearing loss suspected?

4. When was onset of hearing loss suspected?

Ex: as a baby, in childhood, later in life?
5. Does anyone else in the family have hearing loss? Who?

5. Does anyone else in the family have hearing loss? Who?
6. Please describe your concern or reason for seeking information?

6. Please describe your concern or reason for seeking information?

Ex: family planning, understanding disease progression, etc.

7. Was infection testing done upon diagnosis of hearing loss?

7. Was infection testing done upon diagnosis of hearing loss?

Ex: for CMV (cytomgalovirus) or meningitis?
8. Has temporal bone -computed tomography been done?

8. Has temporal bone -computed tomography been done?

To look for enlarged vestibular aqueduct?
9. Has the affected individual or anyone had any genetic testing?

9. Has the affected individual or anyone had any genetic testing?
10. Did affected have low birth weight or require NICU ventilation?

10. Did affected have low birth weight or require NICU ventilation?
11. Does the affected individual have renal (kidney) problems?

11. Does the affected individual have renal (kidney) problems?
12. Does the affected individual have any obvious ear abnormalities?

12. Does the affected individual have any obvious ear abnormalities?

Ex: external ear malformations, or report of internal ear malformations. 
13. Does the person with hearing loss have any eye abnormalies?

13. Does the person with hearing loss have any eye abnormalies?

Such as cataracts, very wide set eyes, blindness, retinitis, significant surgery, etc. (aside from usual near sightedness or far sightedness).  
14. Is there a history in the affected or in the family of:

14. Is there a history in the affected or in the family of:

cardiac abnormalies, fainting, sudden death, long q-t syndrome? 
15. Is there a history in the affected or in the family of:

15. Is there a history in the affected or in the family of:

Thyroid problems, diabetes, gastrointestinal problems
16. Is there a history in the affected or in the family of:

16. Is there a history in the affected or in the family of:

Pigmentation defects of the skin, eyes or hair
17. Is there a history in the affected or in the family of:

17. Is there a history in the affected or in the family of:

birth defects including: cleft palate, facial abnormalities (dysmorphology), limb abnormalities, short stature, neurodevelopmental or neurobehavioral issues (includes delay, mental retardation and mental illness)?
18. Does anyone else in the familly have any of:

18. Does anyone else in the familly have any of:

Any of the conditions listed on this form, considering ALL questions?
19. List significant hospitalizations:

19. List significant hospitalizations:

Of hearing-loss affected individual or any relative with issues mentioned.
20. Verifier

20. Verifier

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