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Supplemental Newborn Screening
Information for Physicians and Their Staff
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Screening Card
The Institute of Metabolic Disease requires a contract for all physicians or physicians group. To request an information packet or a contract packet, please email us or call us at 214-820-4533.
All screening cards will require a physician's signature in the field designated for "Ordering Physician". The signature of an individual designated by the physician to sign on this behalf will be accepted. A document indicating this designation must be on file at the physician's office and must be available to Baylor upon request. Screening or resulting of a specimen may be delayed if the card or the informed consent form is incomplete.
Results are reported to the ordering physician and/or to person(s) designated in your contract. Please print the name of the ordering physician and provide the mailing address, telephone and fax number of the ordering physician in the fields designated for "Mail results to:", "Tel:" and "Fax:". Laboratory personnel are not permitted to provide patient results to anyone other than the ordering physician or designated healthcare providers without a signed, written authorization from the parent or legal representative.
All initial screening cards require informed consent. The consent must be signed or dated by a parent or legal representative and a witness. The informed consent is printed on a label located on the glassine storage envelope provided by the Institute. Screening or resulting of a specimen may be delayed if the card or the informed consent form is incomplete. Repeat screens requested by the IMD do not require a second informed consent.
If you choose the contract that requires patients to pay the Institute, it would be your responsibility to inform the parent or patient that payment must accompany the screening card. The check should be placed inside the regular mailing envelope.
The current cost of the screening is $35.00 and checks should be made payable to Baylor Institute of Metabolic Disease.
All screening results will be sent to the ordering physician's office or practice.
Information needed to perform the screening:
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