Newborn Screening for Metabolic and Sickle Cell Disorders Program

Screening: Completing the Form

All information requested on this form is vital for the Screening, Follow-up, and Diagnosis components of the newborn screening process. It must be accurate, legible and complete.

The laboratory uses this information to determine whether results are normal or abnormal based on date of birth, date of collection, birth weight, time of birth, and time of collection. Omitting this information can cause unnecessary repeats.

The laboratory also reports this information to the Follow-up Programs, which then use this information to locate the child and make appropriate follow-up decisions and recommendations. Omitting this information can delay the follow-up program in locating a child, possibly resulting in a delayed diagnosis or an unnecessary death.

Sample Newborn Screening Form (Form 3491) 

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