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newborn screening program (NBS)

NBS Consent 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 4408 (PDF)
    Consent for Disclosure and/or Release of Confidential Information from GDSP
  • CDPH 4408 SP (PDF)
    El consentimiento para la divulgación y / o Divulgación de Información Confidencial de GDSP
  • CDPH 4410 (PDF)
    Parent Request to Have Newborn Blood Specimen Card Destroyed 
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