Individual Request for Newborn Screening Blood Spots Authorization to Release Healthcare Information


Details & Requirements

Some portion of the blood spots of the newborn will be released to the person, clinic, or organization named in this form.


Customer Reviews

Customer Reviews

Details & Requirements

Some portion of the blood spots of the newborn will be released to the person, clinic, or organization named in this form.

Signer Resources

  • Cost: $25 + $10 per added notary seal

  • Avg Notarization Time: Eight minutes

  • Cost: $25 + $10 per added notary seal

  • Avg Notarization Time: Eight minutes