Get the free Newborn Screening Refusal Form - New Hampshire Department of ... - dhhs nh

STATE OF NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH SERVICES 29 HAVEN DRIVE, CONCORD, NH 03301-6527 603-271-4225 1-800-852-3345 Ext. 4225 Fax: 603-271-4519 TDD

How to fill out newborn screening refusal form

Point by point, here is how to fill out a newborn screening refusal form:

1. Obtain the form: First, you need to acquire a newborn screening refusal form. This form can typically be obtained from your healthcare provider or the hospital where the birth took place.
2. Provide personal information: Fill out the necessary personal information on the form. This may include the baby's name, date of birth, gender, and other identifying details. Additionally, you may need to provide your own contact information as the parent or guardian.
3. State the reason for refusal: Clearly state your reason for refusing newborn screening. This can include personal beliefs, religious reasons, or any concerns you may have regarding the procedure. Be sure to provide a detailed explanation to support your decision.
4. Sign and date the form: Once you have completed all the necessary information, carefully read through the form to ensure accuracy. Then, sign and date the form to confirm your refusal. If applicable, both parents may need to sign the form depending on legal requirements.
5. Submit the form: Return the completed newborn screening refusal form to the appropriate healthcare provider or hospital. Ensure that you follow their specific instructions for submission, such as mailing it or hand-delivering it to the designated office.

Who needs a newborn screening refusal form?

1. Parents or legal guardians who have made the decision to refuse newborn screening for their child.
2. Individuals who have personal beliefs, religious reasons, or concerns about the procedure and wish to exercise their right to refuse.

Remember, it is important to consult with healthcare professionals and consider the potential risks and benefits associated with newborn screening before making a decision.

For pdfFiller’s FAQs

What is newborn screening refusal form?

The newborn screening refusal form is a document that allows parents or legal guardians to officially decline newborn screening for their child.

Who is required to file newborn screening refusal form?

Parents or legal guardians of newborn babies are required to file the newborn screening refusal form if they choose to refuse the screening.

How to fill out newborn screening refusal form?

To fill out the newborn screening refusal form, parents or legal guardians need to provide their personal details, the newborn's information, and sign the form to indicate their refusal of the screening.

What is the purpose of newborn screening refusal form?

The purpose of the newborn screening refusal form is to inform healthcare providers and authorities about the decision of the parents or legal guardians to decline the newborn screening for their child.

What information must be reported on newborn screening refusal form?

The newborn screening refusal form typically requires the personal information of the parents or legal guardians, such as their names, contact details, and the newborn's information, including name, date of birth, and other relevant details.

When is the deadline to file newborn screening refusal form in 2023?

The deadline to file the newborn screening refusal form in 2023 may vary depending on the specific jurisdiction or healthcare facility. It is recommended to consult with the relevant authorities or healthcare provider to determine the exact deadline.

What is the penalty for the late filing of newborn screening refusal form?

The penalty for the late filing of the newborn screening refusal form may vary depending on the jurisdiction or healthcare regulations. It is advisable to review the local laws or consult with the relevant authorities to understand the specific penalties or consequences for late filing.

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