Newborn blood spot screening supply order form

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For use by health professionals only.

Only order a three (3) month supply maximum. Practitioners who use the CDPHE Newborn Blood Spot Screening Lab are not charged for supplies.

The State Lab reserves the right to change the requested amounts on the order due to availability of supplies.

An automated submission receipt will be sent to the email provided. This email address will be associated with your account.

Allow 2-3 business days to process your order.

If you have questions or concerns, email the Newborn Blood Spot Screening program at conbs_cdphe@state.co.us.

For questions about courier services, email CDPHE_courier@state.co.us.

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E-Mail-Adresse *

Submitting facility name *

Submitter type:

Shipping address (PO Box not accepted) *

Shipping address II (suite, floor, etc.)

City *

State *

Sonstiges:

ZIP code *

Contact information

First name *

Last name *

Phone number *

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Dieses Formular wurde bei State.co.us Executive Branch erstellt.

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