Sec. 10.10.13.13. Screening Test Blood-Spot Specimens — Collection and Test Requisition

A. Blood-Spot Specimen Collection.

(1) A person shall collect a newborn infant’s blood-spot specimen for testing under this chapter by using only the special blood-spot specimen collection test requisition card provided by the Department.

(2) The Department shall provide the special blood-spot specimen collection test requisition card to the:

(a) Individual in charge of a birthing facility or the individual’s designated representative; or

(b) Home birth attendant.

(3) The individual in charge of a birthing facility or the individual’s designated representative, or the home birth attendant shall collect a blood-spot specimen consisting of heel-stick whole blood obtained:

(a) When a newborn infant is 24 to 48 hours old;

(b) On a blood-spot specimen collection test requisition card provided by the Department; and

(c) As set forth in Regulation .14 of this chapter.

B. Blood-Spot Specimen Collection Test Requisition Card Information. An individual shall record the following information as specified on the Department-supplied blood-spot specimen collection test requisition card:

(1) Newborn infant information, including:

(a) Name;

(b) Date of birth;

(c) Time of birth;

(d) Current weight;

(e) Gender;

(f) Race;

(g) Gestational age;

(h) Birthing facility identification, including the:

(i) Facility name;

(ii) Facility street address, city, state, and zip code; and

(iii) Newborn infant's medical record or chart number;

(i) Date and time of first feeding;

(j) Type of feeding, such as:

(i) Breast;

(ii) Lactose-containing formula; or

(iii) Formula containing no lactose;

(k) Transfusion history, including transfusion date and time;

(l) General health status of the newborn infant; and

(m) The total protein and calorie intake for any newborn infant in a neonatal intensive care setting;

(2) Blood-spot specimen information, including:

(a) Date of collection;

(b) Time of collection; and

(c) Initials or other identifier of the individual who collected the blood-spot specimen;

(3) Mother or guardian information, including:

(a) Name;

(b) Street address, city, state, and zip code; and

(c) Telephone number where the mother or guardian may be reached;

(4) Information on the pediatrician or attending physician who will be following the newborn infant, including the physician's:

(a) Name;

(b) Street address, city, state, and zip code; and

(c) Telephone number; and

(5) Other information that can affect the test results or the interpretation of the test results when applicable, such as that antibiotics were administered to the:

(a) Mother; or

(b) Newborn infant.