× The federal government has shut down due to the failures of the President and Congress to continue government funding. Millions of Californians receiving benefits from state programs may be impacted. For now, California’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) will continue to provide services and enroll eligible families as long as funding is available. No new federal funding to California WIC will be provided until the President and Congress take action. Families should continue to use their WIC benefits and attend their WIC appointments. This information is subject to change, so please monitor the California WIC website for updates.

Please be wary of potential highly partisan political messaging while visiting federal government websites for information related to the federal government shutdown.

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Genetic disease screening program

 

Genetic Disease Screening Program Forms

 
 

CDPH 4009 (PDF) - Confidential Case Report of RH Hemolytic Disease of the Newborn

CDPH 4010 (PDF) - Newborn Screening (NBS) Provider Order Form

CDPH 4400 (PDF) - NCAA Student Athlete Request for Newborn Screening Hemoglobin Results

CDPH 4403 (PDF) - Request for Newborn Screening Hemoglobin Results

CDPH 4406 (PDF) - Newborn Screening Transport Log

CDPH 4407 (PDF) - Consent for Release of Dried Blood Specimen from GDSP

CDPH 4407 SP (PDF) - Consent for Release of Dried Blood Specimen from GDSP (Spanish Version)

CDPH 4408 (PDF) - Consent for Disclosure and/or Release of Confidential Information from GDSP

CDPH 4408 SP (PDF) - Consent for Disclosure and/or Release of Confidential Information from GDSP (Spanish Version)

CDPH 4410 (PDF) - Parent Request to Have Newborn Blood Specimen Card Destroyed

CDPH 4410 SP (PDF) - Parent Request to Have Newborn Blood Specimen Card Destroyed (Spanish Version)

CDPH 4427 (PDF) - Confidential Case Report of a Birth Defect in a Fetus or Infant Less Than One Year of Age

CDPH 4453 (PDF) - Request for California Prenatal Screening Program Supplies (For Clinicians and Labs Only)

CDPH 4487 (PDF) - California Genetic Counselor Temporary or Renewal Form

CDPH 4488 (PDF) - Genetic Counselor Licensure Continuing Education Declaration

CDPH 4489 (PDF) - California Genetic Counselor Licensee Data Change Request

CDPH 4490 (PDF) - Genetic Counselor Fingerprint Card Request

CDPH 4491 (PDF) - California Genetic Counselor License Verification

CDPH 4518 (PDF) - Nuchal Translucency (NT) Exam Data

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*If you are having difficulty accessing any of these documents, please contact CDPH at (916) 558-1784 to request information in an alternate format.
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