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  • 5861 NF 0007

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    Recto Pineda
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    The document is an unsatisfactory letter from a Newborn Screening Center requesting verification of feeding information that was missing from a specimen collection card. It provides the details of the missing information - the baby's last name, mother's first name, sex, date of birth, and date of collection. It requests that the birthing station coordinator provide a signed letter or use an included data verification form to supply the missing feeding information for the newborn screening program record. Contact information is provided for any inquiries.

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    The document is an unsatisfactory letter from a Newborn Screening Center requesting verification of feeding information that was missing from a specimen collection card. It provides the details of the missing information - the baby's last name, mother's first name, sex, date of birth, and date of collection. It requests that the birthing station coordinator provide a signed letter or use an included data verification form to supply the missing feeding information for the newborn screening program record. Contact information is provided for any inquiries.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    3 views1 page

    5861 NF 0007

    Uploaded by

    Recto Pineda
    The document is an unsatisfactory letter from a Newborn Screening Center requesting verification of feeding information that was missing from a specimen collection card. It provides the details of the missing information - the baby's last name, mother's first name, sex, date of birth, and date of collection. It requests that the birthing station coordinator provide a signed letter or use an included data verification form to supply the missing feeding information for the newborn screening program record. Contact information is provided for any inquiries.

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    of 1

    Newborn Screening Center

    Central Luzon

    UNSATISFACTORY LETTER
    January 09, 2024
    URGENT!
    NBS COORDINATOR
    5861 RHU - GABALDON BIRTHING STATION
    SUBJECT: REQUEST FOR VERIFICATION - NO FEEDING INFORMATION

    Please be informed that the specimen collection card of the patient indicated below was noted to have NO FEEDING
    INFORMATION.
    Baby's Last Name Mother's First Name Sex Date of Birth Date of NBS Collection
    January 2, 2024 10:20AM January 3, 2024 01:30PM
    SUSA MICCA JOY FEMALE

    We would like to REQUEST FOR A DULY SIGNED LETTER OF VERIFICATION or you may use our DATA VERIFICATION FORM
    (please see below). The letter or form can be sent through fax at (045) 624 6502/ (045) 624 6503. You may also send via email
    at nscaufmc@gmail.com or through courier.
    For inquiries or clarification, please contact ,Roselle Ann Limpin, at (045) 624 6502/ (045) 624 6503 / 09206689855.

    Thank you very much for your unending support of the National Comprehensive Newborn Screening Program.
    Sincerely,
    Roselle Ann Limpin
    Unsat Recall Officer
    DATA VERIFICATION FORM
    I. NEWBORN SCREENING FACILITY INFORMATION
    *Code
    *Name of Facility
    *Address
    *Name of NBS Coordinator
    *Contact Number/s
    *Fax Number/s
    *E-mail Address
    I. PATIENT DATA VERIFICATION
    PURPOSE OF VERIFICATION NO FEEDING INFORMATION
    LABORATORY NUMBER 20240080007
    *Filter Card Number
    *Baby's Last Name
    *Mother's First Name
    *Sex
    *Date and Time of Birth
    *Date and Time of Collection
    *Age of Gestation
    *Birth Weight
    *Feeding
    *Baby's Status
    *FEEDING (Please check (v) type of feeding)
    1.________Breast 5.________TPN
    2.________Lactose Formula 6.________1 & 2
    3.________Soy/Lactose-Free 7.________1 & 3
    4.________NPO

    *Printed Name and Signature of Attending Physician/NBS Coordinator


    *Date Signed:
    Note: *Please fill in all required information.

    Angeles University Foundation Medical Center, MacArthur Highway, Angeles City 2009
    Mobile Nos. (0917) 820-8118 / (0933) 864-8868 / (0933) 816-3730 | E-m ail: nscaufmc@gmail.com

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