Get Nbs Results Release Form - California Department Of Public Health ... - Cdph Ca

The NBS Results Release Form is an important document that facilitates the disclosure of newborn screening test results. This guide provides clear, step-by-step instructions on how to complete this form online, ensuring a smooth and efficient process.

Follow the steps to complete the NBS Results Release Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the section requesting newborn screening results, which includes providing the name of the newborn, their gender, date of birth, and the hospital of birth.
3. Fill in the mother's full name, last name on the date of birth, and date of birth.
4. Provide the home address on the date of birth, ensuring it is accurate for records.
5. Indicate the name and address of the individual or entity to whom the records will be released.
6. Include the phone number and fax number of the individual or entity receiving the records.
7. Specify the expiration date of the authorization for disclosure.
8. Sign the form and print the name of the parent or legal guardian. Note that the signature should be provided by the parent or guardian if the request is for a minor.
9. Enter the date signed, as well as the home and work phone numbers of the signer.
10. Review all entered information for accuracy before submission.
11. Once completed, save the changes, download, print, or share the form as required.

Start filling out your NBS Results Release Form online today!