Newborn Screening Refusal Form - Alabama Department of Public - adph 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your child’s name and date of birth in the designated fields. This information is crucial for identifying your child within the newborn screening program.
3. Next, fill in the name of the delivery hospital where your child was born. This helps provide context for your child's medical history.
4. In the section for Parent/Legal Guardian, enter your full name. This identifies you as the decision-maker regarding your child's participation in the screening.
5. Indicate whether you choose to decline participation by checking the appropriate box. Ensure you understand the implications of this decision as outlined in the form.
6. Sign and date the form at the bottom, confirming that you have read and understood all information provided about newborn screening.
7. If required, have a witness sign and date the form as well, ensuring all necessary parties are acknowledged.

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