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Get PA Request For Specimen Release Form 2019-2024

For specimen release, please return this completed form to the Department of Health before the child s first birthday via mail or fax: Pennsylvania Department of Health Division of Newborn Screening and Genetics 625 Forster Street, 7th Floor East Harrisburg, PA 17110 Fax: 717-724-6995. Please provide the following: Birth Facility Infant s Date of Birth.

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