Providers – Dried Blood Spot Newborn Screening

Send secure communication, including follow-up, to the NBS Follow-Up Team

Resources

Guide to Collecting Dried Blood Spot Newborn Screens

How are Normal, Abnormal and Critical Screening Results Reported to You and Followed-Up?

Cystic Fibrosis (CF) Screening in Virginia

The American College of Medical Genetics and Genomics (ACMG) ACT sheets

Critical Congenital Heart Disease (CCHD)

Early Hearing Detection and Intervention (EHDI) Program

Forms

Record Request by Health Care Provider for Continuity of Care:

Send a fax with your practice letterhead requesting the results to the state lab at 804-225-2595. Include DOB, mom’s last name, and birth hospital if known.

Notification of Parental Refusal of Dried-Blood-Spot and Critical Congenital Heart Disease Screening

To be completed and signed by the infant’s parent or guardian who refuses the newborn blood spot screening on the grounds that such test conflicts with his/her religious practices or tenets.

Newborn Screening Dried Blood Spot Collection Kit Order Forms

DGS Form 19049 Order Form for Hospitals and Physicians

DGS Form 19050 Order Form for Midwives

Kits may only be ordered by hospitals, midwives, and physicians’ offices, not by private citizens. These kits must be paid for in advance. Submit the completed order form with payment to the Cashier’s Office, Department of General Services for processing. The Cashier’s Office forwards the orders to DCLS once payments have been confirmed.