Pregnant Person Information – PCPNDT Form
Required before prenatal ultrasound, as per Govt of India Laws

Welcome to Texas Imaging and Labs. As per the PCPNDT Act, certain details are mandatory before conducting Pregnancy Ultrasound Scan. Completing this form in advance will help speed up your registration.

Before you begin:
  • Enter your Name exactly as per your Aadhaar card. If using insurance, ensure it matches your policy.
  • Your information is confidential and used only for compliance.

Thank you for helping us maintain accurate and lawful medical records.

Patient Pregnancy
date_time
id
Enter the pregnant woman’s full legal name as per Aadhaar Card.
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Enter complete address: house/flat number, building name, street, area, city, state, and PIN code.
Enter a nearby landmark that helps identify the location (e.g., near ABC School).
Enter a valid 10-digit mobile number.
Select whether the pregnant person is married, unmarried, divorced, or widowed.
Enter the full name of the father as per ID proof.
Enter the husband’s full name.
Enter the full name and address of the referring doctor
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Select the date of the pregnant person’s last menstrual period.
Enter total number of living children (sons + daughters).
Living Children Details
Child’s Gender Child’s Name Date of Birth
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