Skip Navigation Linksnbsconsentforms

newborn screening program (NBS)

NBS  Forms

Consent for Disclosure and/or Release of Confidential Information from GDSP and Request to Restrict Use and Disclosure of Personal Information.

To receive a copy of your child's newborn screening results, please complete and return form below, CDPH 4408.

  • CDPH 4406 (PDF)
    Newborn Screening Transport Log
  • CDPH 4407 (PDF)
    Consent for Release of Dried Blood Specimen from GDSP
  • CDPH 4407 (PDF)
    Consentimiento Para La Liberación de Muestras de Sangre Seca de GDSP
  • CDPH 4010 (PDF)
    Newborn Screening (NBS) Provider Order Form
  • CDPH 4408 (PDF)
    Consent for Disclosure and/or Release of Confidential Information from GDSP
  • CDPH 4408 SP (PDF) 
    Consentimiento Para La Divulgación y / o Divulgación de Información Confidencial de GDSP
  • CDPH 4410 (PDF)
    Parent Request to Have Newborn Blood Specimen Card Destroyed 
  • CDPH 4410 (PDF)
    Solicitud Para Los Padres Para Destruir La Tarjeta de Muestra de Sangre del Recién Nacido 
  • CDPH 4400 (PDF)
    NCAA Student Athlete Request for NBS Results

 

Page Last Updated :