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