Newborn Screening - Specimen Collection Requirements

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Healthcare Provider Requirements to Collect the Newborn Screen

Texas rules state that:

  • The 1st newborn screen should be collected between 24 - 48 hours of age, or before hospital discharge.
  • The 2nd newborn screen should be collected on every infant at 7-14 days, a minimum of 168 hours, of age.

For more information regarding the rules outlining a Healthcare Provider’s requirement to collect the newborn screen, see the Texas Administrative Code for Newborn Screening.

For more information regarding collection of the newborn screening specimen when special circumstances exist such as premature infants, transfusions, facility transfers, TPN, etc. visit Specimen Collection - Special Circumstances.

Newborn Screening (NBS) Specimen Collection Supplies

Supplies required:

  • NBS 3 (Medicaid) or NBS 4 (Private Pay) Specimen collection kit
  • Heel Lancet
    • Depth of 1.00mm and length of <2.00mm.
    • For premature infants: The lancet should not exceed a depth of .85mm and length of 1.75mm.
  • Alcohol
  • Gloves

Optional supplies:

  • Mailing envelopes
  • Provider address labels

Order Form for Newborn Screening Supplies

Instructions for Pages 1-3 of the Newborn Screening Kit

Texas Newborn Screening Parent Information (Page 1):

  • Fill out baby’s information on the top PARENT COPY form
  • Give copy to parent for all screens. For 1st screens explain that the form must be taken to the baby’s doctor at the baby’s 7-14 day checkup.

Parental Decision for Storage/Use of Newborn Screening Blood Spot Cards (Page 2):

  • Parent or submitter may fill out Section 1. A patient label with the requested information is acceptable.
  • Parent reviews, completes, and signs form.
  • Submitter returns the form to DSHS with blood spot cards if parent requests.
  • It is the parent’s option to take the form home and return to DSHS by mail at a later date.

Demographic Form (Page 3):

  • Legibly print ALL information. USE BLACK INK AND BLOCK CAPITAL LETTERS. Press hard for good copies. Do not touch the filter paper blood collection spots.
  • For 2nd screens: If available, fill in the serial number for the baby’s 1st screen in the box “Previous Specimen Serial Number.”
  • Fill in the number to indicate baby’s ‘Sex’, ‘Feed’, ‘Ethnicity’, ‘Status’, and ‘Baby’s Age at Time of Collection/Test.’
  • If the specimen is a repeat for a previous abnormal, fill in the Texas DSHS laboratory number in appropriate spaces.
  • Under Submitter Information, fill in the address where the results are to be sent. Labels for this may be ordered using the Order Form for Newborn Screening Supplies (above).
  • After information and Decision Form have been provided, check the box on demographic information sheet that indicates “Check to verify parent information & decision form distributed.”
  • Remove and keep the yellow submitter copy of the demographic information.

**Accurate information on the demographic form is vital to testing and result follow-up. Please take extra care when completing this information. **

Impact of incorrect demographic information includes but is not limited to:

  • Rejection of specimen for testing
  • Wrong result reported (normal vs. abnormal)
  • Result released to wrong healthcare provider.
  • Delay in initiation of follow-up for an abnormal result.

Recommended Specimen Collection Technique

Gloves should be worn for personal safety. Care should be taken to avoid contamination of blood collection circles with antiseptic solutions, powders, lotions or other materials which may contaminate and adversely affect the testing process.

  • Place baby’s limb in dependent position.
  • Cleanse skin with alcohol, DRY, and puncture with disposable heel lancet (<2.0mm length).
    • DO NOT use any product with chlorhexidine gluconate, such as Chlorascrub Swabs.
    • DO NOT use alcohol swabs with topical pain killers such as benzocaine.
  • Wipe off first drop of blood.
  • Allow a drop of blood to form and apply DIRECTLY to filter paper. Apply to one side only while viewing from the other side to ensure COMPLETE SATURATION OF THE ENTIRE CIRCLE.
  • Complete one circle at a time and FILL ALL FIVE (5) CIRCLES.
  • Allow card to dry thoroughly at room temperature in a horizontal position for at least 3 hours. Do NOT allow specimen to touch any surface.
  • Cover dried specimen with attached flap.
  • Ship dried specimen AS SOON AS POSSIBLE WITHIN 24 HOURS, preferably via overnight courier. If mail or carrier services are unavailable, ship as quickly as possible. See shipment information section below.

The heel-stick is always the preferred method for collection of the newborn screening. If it is not possible to perform a heel-stick, please see the Alternative Methods for Collecting a Newborn Screen page for detailed information and instructions.

Additional Information on Recommended Specimen Collection Techniques

Shipment of the Newborn Screening Specimen

Quick delivery of specimens is imperative. Some disorders need to be identified, diagnosed and treated as soon as possible to prevent onset of clinical symptoms. For example, congenital adrenal hyperplasia and galactosemia may cause life-threatening symptoms by the first week of life.

It is important that submitting facilities are mindful of the time between collection and shipment. New national recommendations state that first screen specimens should arrive at the DSHS Laboratory within 24 HOURS AFTER COLLECTION. To facilitate timely identification and treatment of critical disorders, it is recommended that specimens be shipped via overnight courier and received in the laboratory for testing the day after collection.

For Overnight/Courier Shipping (UPS, FedEx, etc.):

Texas Department of State Health Services
Laboratory Services Section, MC 1947
1100 W. 49th Street
Austin, TX 78756-3199

For USPS Regular and Priority Mail:

Texas Department of State Health Services
Laboratory Services Section, MC 1947
PO Box 149341
Austin, TX 78714-9341

Refusal / Objection to Screening

A parent can refuse or object to the screen for religious reasons only (Texas Health & Safety Code Sec. 33.012).  Make sure you and your staff are familiar with the benefits of screening and the consequences of undetected disorders.

Points to consider before refusing/objecting to newborn screening:

  • There are important medical benefits of newborn screening.
  • Symptoms of a newborn screening disorder can appear much later, after a child’s health has already been injured by the disease.
  • The screen is mandated by law.
  • The only legal reason to refuse newborn screening is if it conflicts with the parent’s religious tenets or practices.

Provide the information outlined above to parents who are considering refusing the screen. Download the FORM TO REFUSE THE NEWBORN SCREENING BLOOD TEST or the version in Spanish FORMULARIO DE RECHAZO DE LA PRUEBA DE DETECCIÓN TEMPRANA EN SANGRE A RECIÉN and provide to parents who are sure they want to refuse newborn screening for their infant. The refusal of newborn screening must be signed by the parent/legal guardian/managing conservator and entered in the infant’s medical record. 

English Form: 


Spanish Form:



Additional Specimens Following Abnormal or Unsatisfactory Screen Results

Newborn Screening Result Reports are mailed, faxed or electronically transmitted (Texas Newborn Screening Web Application or HL7) to the submitter (the facility that collected the screen) 4 to 8 days after receiving the specimen.

Abnormal Results

  • Newborn Screening Clinical Care Coordination staff will communicate abnormal newborn screening results to assure appropriate follow-up.  

NBS collection follow-up instructions

Unsatisfactory Results
The result report for unsatisfactory specimens will state "UNSATISFACTORY - PLEASE RESUBMIT". The submitting facility is responsible for ensuring that a follow-up specimen is submitted for any unsatisfactory 1st screen.

If a baby has had two newborn screens and one was “unsatisfactory,” refer to the chart below when determining the necessity to collect a 3rd newborn screen:

1st screen

2nd screen

3rd screen necessary?



No, if full term baby with a birth weight ≥2,500g

Yes, if low birth weight or premature baby with a birth weight of <2,500g



yes, up to 12 months of age.



Please follow recommendations received from DSHS Newborn Screening Clinical Care Coordination Team.



Please follow recommendations received from DSHS Newborn Screening Clinical Care Coordination Team.

Please Note: Submitting unsatisfactory specimens causes the inconvenience of retesting and delays the screening of the newborn, placing the newborn at risk for delayed diagnosis of a screened condition. Please make every effort to follow proper specimen collection techniques.

Spotfocus Newborn Screening Quality Improvement Hints