AL Newborn Screening Program Reorder Form free printable template

BUREAU OF CLINICAL LABORATORIES SHARON P. MASSING ALE, Ph.D., HELD(ABB) ? DIRECTOR Alabama Newborn Screening Program Reorder Form In order to assure that you have an adequate supply of newborn screening

How to fill out alabama screening form

How to fill out AL Newborn Screening Program Reorder Form

1. Obtain the AL Newborn Screening Program Reorder Form from the official website or your healthcare provider.
2. Fill out the 'Contact Information' section with your name, phone number, and email address.
3. Provide the 'Facility Information' by entering the name, address, and phone number of the facility requesting the reorder.
4. Specify the 'Quantity' of screening kits or materials you need in the appropriate section.
5. Indicate the 'Type of Specimen' if applicable, such as blood specimens or hearing screening.
6. Review your entries for accuracy and completeness.
7. Sign and date the form to confirm that the information is correct.
8. Submit the completed form via the designated submission method, usually by fax or online.

Who needs AL Newborn Screening Program Reorder Form?

1. Healthcare providers such as hospitals, clinics, and pediatric offices that conduct newborn screenings.
2. Parents or guardians of newborns who require additional screening supplies for their infants.

Video instructions and help with filling out and completing alabama screening form

Instructions and Help about alabama screening form

Music welcome to the Alabama newborn screening program I'm sorry she Johnson nurse educator with the newborn screening program this video is designed to provide you with a comprehensive overview of the newborn screening program in Alabama we will discuss the disorders that are currently included on the primary panel of disorders describe appropriate hearing screen methods and identify the seven critical congenital heart defects that can be detected through pulse oximetry screening newborn screening began in the 1960s when Dr Robert Guthrie developed a test that could detect phenylketonuria also known as PKU from a single dried blood spot in 1964 Alabama began screening for PKU using the Guthrie screening method since then Alabama has added a total of 31 primary disorders to the newborn screening panel which is currently mandated by law today newborn screening is the description given to three simple procedures that can help identify infants with certain serious genetic and in born conditions even before they show signs and symptoms these are usually completed at the hospital of birth by two days of age newborn screening includes a newborn blood spot screen a newborn hearing screen and a pulse oximetry screen the initial blood spot screen should be collected on all infants by 48 hours of age this helps to ensure timely screening for critical conditions that can cause symptoms as early as the first week of life this test requires five large drops of blood approximately one-tenth the CC each to be applied to the filter paper portion of a specially manufactured collection form which is provided by the Alabama Bureau of clinical laboratories the newborn hearing screen should be done at least 12 hours after birth and can be completed by one of two methods the bioacoustic emissions or OAE screen or the automated auditory brain stem response or an ABR screen the pulse oximetry screen should be completed at 24 to 48 hours of age to detect the possible presence of a critical congenital heart defect or CCD currently Alabama screens for 29 primary conditions from the newborn blood spot screen for this reason it is no longer accurate to refer to the blood spot screen as the PKU it should now be called the newborn screen or newborn blood spot screen instead this screen is used to detect the possible presence of sickle-cell disease and related human hemoglobin APA this however this is only routinely completed on the initial screen which is usually collected on the a-form newborn screening also tests for cystic fibrosis the endocrine disorders congenital hypothyroidism and congenital adrenal hyperplasia biotin 'days deficiency galactosemia severe combined immunodeficiency disease and a panel of metabolic disorders' sickle cell disease is among the more prevalent conditions that are identified through newborn screening this autosomal recessive condition occurs when a child inherits an abnormal hemoglobin gene from each parent when both parents are carriers...

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What is AL Newborn Screening Program Reorder Form?

The AL Newborn Screening Program Reorder Form is a document used to request additional newborn screening test kits and supplies from the Alabama Department of Public Health.

Who is required to file AL Newborn Screening Program Reorder Form?

Healthcare providers and facilities that conduct newborn screenings in Alabama are required to file the AL Newborn Screening Program Reorder Form when they need to replenish their testing supplies.

How to fill out AL Newborn Screening Program Reorder Form?

To fill out the AL Newborn Screening Program Reorder Form, you must provide your facility's information, the quantity of test kits needed, and any additional contact information as required on the form.

What is the purpose of AL Newborn Screening Program Reorder Form?

The purpose of the AL Newborn Screening Program Reorder Form is to ensure that healthcare providers have the necessary supplies to conduct timely screenings of newborns for various genetic, metabolic, and endocrine disorders.

What information must be reported on AL Newborn Screening Program Reorder Form?

The information that must be reported on the AL Newborn Screening Program Reorder Form includes the name and address of the facility, contact information, and the quantity of test kits being requested.