Get the free Newborn Screening Specimen Release Request Form - NJ.gov
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DEPARTMENT OF HEALTH GovernorPO BOX 371 TRENTON, N.J. 086250371TAHESHA L. WAYwww.nj.gov/healthPHILIP D. MURPHYKAITLAN BASTON, MD, MSC, DFASAM CommissionerLt. GovernorNewborn Screening Specimen Release
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How to fill out newborn screening specimen release
How to fill out newborn screening specimen release
01
Obtain the newborn screening specimen release form from the hospital or healthcare provider.
02
Fill in the newborn's personal details such as name, date of birth, and identification number.
03
Provide the parent's or guardian's information, including name, contact details, and relationship to the child.
04
Indicate the medical facility where the newborn was born and the date of the screening.
05
Review the consent statement and ensure it is signed and dated by the parent or guardian.
06
Submit the completed form to the healthcare provider or the laboratory conducting the screening.
Who needs newborn screening specimen release?
01
Parents or guardians of newborns.
02
Healthcare providers involved in newborn care.
03
Laboratories conducting newborn screening tests.
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What is newborn screening specimen release?
Newborn screening specimen release refers to the process of formally permitting the testing and use of biological specimens collected from newborns for screening purposes, which helps detect certain genetic, metabolic, and congenital conditions.
Who is required to file newborn screening specimen release?
Typically, healthcare providers or institutions that collect newborn screening specimens are required to file the newborn screening specimen release.
How to fill out newborn screening specimen release?
To fill out the newborn screening specimen release, one must provide accurate and complete information such as the newborn's name, date of birth, medical record number, and parent's consent where applicable.
What is the purpose of newborn screening specimen release?
The purpose of newborn screening specimen release is to ensure that collected specimens can be used legally for testing purposes, which is essential for early detection and intervention of potential health issues in newborns.
What information must be reported on newborn screening specimen release?
Information that must be reported includes the newborn's identification details, the date and time of specimen collection, healthcare provider details, and consent status for testing.
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