Form SCH-7 "Notice of Availability of Supplemental Newborn Screening" - New Jersey

What Is Form SCH-7?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SCH-7 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form SCH-7 "Notice of Availability of Supplemental Newborn Screening" - New Jersey

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State of New Jersey
Department of Health
NOTICE OF AVAILABILITY OF SUPPLEMENTAL NEWBORN SCREENING
Mandated Newborn Screening
New Jersey law mandates that every baby born in New Jersey receive:
Newborn Biochemical (Bloodspot) screening
Hearing screening
Critical Congenital Heart Defect (pulse oximetry) screening
For more information about the NJ Newborn Screening Program see
https://www.nj.gov/health/fhs/nbs/
Supplemental (additional, optional) screening
The purpose of this notice is to inform expectant parents that New Jersey does not test for every
possible birth defect and that additional, supplemental, testing is available for defects for which
the State does not screen, should you choose to pursue further screening.
Supplemental
screening is performed by private laboratories and may not be covered by
your insurance plan.
The results of any supplemental screening tests are sent to the ordering health professional and NOT to the NJ
Newborn Screening Program.
For more information about supplemental testing, visit:
https://www.babysfirsttest.org
https://babyfoodsteps.wordpress.com/babynewborn-screeningsteps/supplemental-newborn-screening/
*
For general information about Newborn Screening see
https://www.babysfirsttest.org/newborn-screening/screening-101
*
*The NJ Department of Health is not responsible for the content of these web pages.
If you have any questions, please contact your healthcare provider.
Acknowledgement of Receipt of Notice of Availability of Supplemental Newborn Screening
By signing this form, I confirm that:
My health care provider gave me the notice titled “Notice of Availability of Supplemental Newborn Screening”
and I kept a copy of the notice; and
My health care provider gave me a reasonable opportunity to read the notice and ask questions; and
I understand that mandated newborn screening performed by the New Jersey newborn screening laboratory will
not detect all birth defects in infants for which tests are available; and
I understand that I am personally responsible for the cost of additional, supplemental, newborn screening
laboratory services that I choose to pursue.
Relationship to Newborn (check one):
Parent
Guardian
Date: ____________________________
Print Name:
____________________________________ Signature: ___________________________
Print Name of Witness: ____________________________________ Signature: ___________________________
The health care provider shall maintain the signed original of this acknowledgement.
The health care provider shall give the signer a copy of this notice titled, “Notice of Availability of Supplemental Newborn
Screening.”
SCH-7
JULY 2020
State of New Jersey
Department of Health
NOTICE OF AVAILABILITY OF SUPPLEMENTAL NEWBORN SCREENING
Mandated Newborn Screening
New Jersey law mandates that every baby born in New Jersey receive:
Newborn Biochemical (Bloodspot) screening
Hearing screening
Critical Congenital Heart Defect (pulse oximetry) screening
For more information about the NJ Newborn Screening Program see
https://www.nj.gov/health/fhs/nbs/
Supplemental (additional, optional) screening
The purpose of this notice is to inform expectant parents that New Jersey does not test for every
possible birth defect and that additional, supplemental, testing is available for defects for which
the State does not screen, should you choose to pursue further screening.
Supplemental
screening is performed by private laboratories and may not be covered by
your insurance plan.
The results of any supplemental screening tests are sent to the ordering health professional and NOT to the NJ
Newborn Screening Program.
For more information about supplemental testing, visit:
https://www.babysfirsttest.org
https://babyfoodsteps.wordpress.com/babynewborn-screeningsteps/supplemental-newborn-screening/
*
For general information about Newborn Screening see
https://www.babysfirsttest.org/newborn-screening/screening-101
*
*The NJ Department of Health is not responsible for the content of these web pages.
If you have any questions, please contact your healthcare provider.
Acknowledgement of Receipt of Notice of Availability of Supplemental Newborn Screening
By signing this form, I confirm that:
My health care provider gave me the notice titled “Notice of Availability of Supplemental Newborn Screening”
and I kept a copy of the notice; and
My health care provider gave me a reasonable opportunity to read the notice and ask questions; and
I understand that mandated newborn screening performed by the New Jersey newborn screening laboratory will
not detect all birth defects in infants for which tests are available; and
I understand that I am personally responsible for the cost of additional, supplemental, newborn screening
laboratory services that I choose to pursue.
Relationship to Newborn (check one):
Parent
Guardian
Date: ____________________________
Print Name:
____________________________________ Signature: ___________________________
Print Name of Witness: ____________________________________ Signature: ___________________________
The health care provider shall maintain the signed original of this acknowledgement.
The health care provider shall give the signer a copy of this notice titled, “Notice of Availability of Supplemental Newborn
Screening.”
SCH-7
JULY 2020