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Failed screen reporting form place label or write in information Medical Record # Patient Name: Last First Mothers Name: Date of Birth / / Hospital: Medical Provider: Alabama Newborn screening program

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How to fill out failed screen reporting form

01

Step 1: Open the failed screen reporting form

02

Step 2: Fill in your name and contact information

03

Step 3: Specify the details of the failed screen, such as the product name and version

04

Step 4: Describe the issue or error encountered on the screen

05

Step 5: Provide any additional relevant information or screenshots

06

Step 6: Submit the form by clicking the 'Submit' button

07

Step 7: Wait for a response or follow any further instructions provided

Who needs failed screen reporting form?

01

Anyone who encountered a failed screen or error while using a particular product or software

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