Newborn screening request form
[DOCX File]HIPAA Authorization to Obtain Newborn Screening Results
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to Obtain Newborn Screening Results and . for Disclosure of Protected Health Information . It . may take up to three business days to fulfill the request. (F. ax completed request forms to the Pennsylvania Department of Health at 717-724-6995) I authorize the. Pennsylvania . Department of Health (Department) to disclose individual . newborn ...
[DOC File]Request for return of newborn metabolic screening sample
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Request for return of newborn metabolic screening sample (‘Guthrie card’ or ‘blood spot card’) Instructions for requesting return . Who can request return? Until a child is 16 years old, the request must be made by the baby’s parent or legal guardian. After that …
[DOC File]Request for Information - Antenatal and Newborn Screening ...
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Request for Information - Antenatal and Newborn Screening Programmes . Application date: _____ This form must be completed by the person (applicant) requesting information from the Antenatal and Newborn Screening Programmes, including use of residual blood spot samples for research and evaluation purposes.
[DOC File]Secretary's Stationary
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this form to Newborn Screening at 850-922-5385. OR. MAIL Request to: Newborn Screening Follow-Up Program. Children’s Medical Services. FL Department of Health . 4052 Bald Cypress Way, Bin A-06. Tallahassee, FL 32399-1707 (850) 245-4201. Rick Scott. Governor John H. Armstrong, MD, FACS. Surgeon General & Secretary Children’s Medical Services
[DOC File]Home - Florida Newborn Screening
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FAX REQUEST FORM TO: (850) 922-5385 Call (866) 804-9166 for more information regarding interpretation of results or visit www.floridanewbornscreening.com for more information about the Florida Newborn Screening Program . Results for children less than two years of age can be obtained online at: www.fnsr.net. FS 383.14 (1) (c) allows the Department of Health to release newborn screening results ...
[DOT File]New Jersey Department of Health
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Newborn Screening (NBS) - Billing Unit. P. O. Box 361. Trenton, NJ 08625-0361 ORDER FORM FOR. INITIAL NEWBORN SCREENING REQUEST (IEM-1) FORMS Distribution: ORIGINAL-To be Returned to Requester. COPY-NJDOH, Laboratory File. COPY-To be Retained by Requester FORM TITLE QUANTITY COST PER FORM TOTAL COST FOR STATE USE ONLY Initial Newborn. Screening ...
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