Get Refusal-form.doc - Maine

This guide provides clear, step-by-step instructions for filling out the Refusal-form.doc for newborn bloodspot screening in Maine. By following these guidelines, you will be able to complete the form accurately and efficiently, ensuring that all necessary information is provided.

Follow the steps to fill out the refusal form online:

1. Press the ‘Get Form’ button to obtain the Refusal-form.doc and open it in your preferred document editor.
2. Enter your infant’s name in the designated field labeled 'INFANT’S NAME'.
3. Fill in your infant’s date of birth in the field for 'DATE OF BIRTH', ensuring the format is month/day/year.
4. Provide the place of birth in the section labeled 'PLACE OF BIRTH'.
5. Write your name or the name of the guardian(s) in the 'PARENT(S)/GUARDIAN(S) NAME' section.
6. Complete the 'ADDRESS' field with your current residential address.
7. In the section where it states 'I/We refuse to have my baby tested because my religious beliefs do not allow it,' ensure to check or confirm this according to your belief.
8. Sign the document in the 'SIGNATURE' fields, including relationship to the infant and the date of signing.
9. If applicable, have a second parent or guardian provide their signature and relationship details.
10. A witness should fill in their details and sign the appropriate fields.
11. Medical personnel will need to provide their name, title, date, and signature in the designated areas, ensuring all explanations about the testing are acknowledged.
12. Finally, save your changes, download the completed form, print it for your records, or share it as necessary.

Complete your refusal form online today to ensure your preferences are respected.