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This document is a refusal form for parents to opt out of the newborn screening tests offered by the Arizona Department of Health Services, outlining the risks and implications of not conducting these
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How to fill out NEWBORN SCREENING - PARENT REFUSAL FORM

01
Obtain the Newborn Screening - Parent Refusal Form from your healthcare provider or hospital.
02
Read the form carefully and ensure you understand the implications of refusing screening for your newborn.
03
Complete the personal information section, including your name, your newborn's name, and date of birth.
04
Indicate your refusal of the newborn screening by checking the appropriate box on the form.
05
Provide a written explanation for your refusal, if required by your healthcare provider.
06
Sign and date the form at the designated area to validate your refusal.
07
Submit the completed form to the hospital or healthcare provider before your newborn is discharged.

Who needs NEWBORN SCREENING - PARENT REFUSAL FORM?

01
Parents or guardians who choose to opt-out of state-mandated newborn screening for their child.
02
Parents who have specific concerns or beliefs that lead them to refuse the screening.
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Generally, babies with possibly severe health conditions look normal at first. Therefore, parents must have their babies undergo newborn screening to be aware of such conditions as early as possible. Early diagnosis and prompt management may prevent life-threatening problems and help with their normal development.
Most states have newborn screening statutes; however, some allow parents and/or guardians to refuse the screening,7 while other statutes require a refusal to be based on a religious exemption.
The conditions on the newborn screening panel can cause permanent and severe health problems or lead to death if not detected early. If you refuse newborn screening, you must indicate your refusal in writing. Staff from the birth facility will send a copy of the refusal form to the Newborn Screening Program.
If you refuse newborn screening, you must indicate your refusal in writing. Staff from the birth facility will send a copy of the refusal form to the Newborn Screening Program. An original form should be kept in your child's medical chart with a copy given to you by hospital staff or your birth provider.
Newborn screening is a set of tests your baby has 24 to 48 hours after birth. These tests help healthcare providers identify certain health conditions. Newborn screening helps ensure that your baby gets needed treatment as soon as possible.
Newborn screening identifies conditions that can affect a child's long-term health or survival. Early detection, diagnosis, and intervention can prevent death or disability and enable children to reach their full potential.
Parents have the right to decline the hearing screen. However, with proper communication regarding the importance of providing a newborn hearing screen, many parents will decide to have the hearing screen completed before leaving the hospital or birthing center.
Mostly these parents are scared into thinking that something bad will be done with their baby's blood. Something beyond testing it for up to 50 or more life-threatening diseases that are often treatable when detected early, which is why newborn screening tests are a thing.

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The Newborn Screening - Parent Refusal Form is a document that parents can complete if they choose to decline or refuse the screening tests that are typically performed on newborns to check for certain genetic, endocrine, and metabolic conditions.
The parents or legal guardians of a newborn are required to file the Newborn Screening - Parent Refusal Form if they decide to refuse the mandatory newborn screening tests.
To fill out the Newborn Screening - Parent Refusal Form, parents need to provide their newborn's information, indicate their refusal to consent to screening, and sign and date the form. Some forms may require additional details about the reasons for refusal.
The purpose of the Newborn Screening - Parent Refusal Form is to formally document the parents' decision to refuse screening tests for their newborn, ensuring that healthcare providers are aware of the refusal and can offer appropriate counseling on the implications.
The information that must be reported on the Newborn Screening - Parent Refusal Form typically includes the newborn's name, date of birth, parents' or guardians' names, contact information, the date the form is completed, and a statement indicating the refusal of screening.
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