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Philippine Newborn Screening Project Consent Form
Republic of the Philippines
Province of Misamis Occidental
Misamis Occidental Provincial Hospital
Telefax (088) 531-1529, Tel. Nos. (088) 531-1042
As the parent/guardian of __(Name of baby)____ I, ___(Name of guardian)___ am consenting to include my baby in the "Newborn Screening Project, Details on Newborn Screening have been explained to me and I am allowing the medical personnel involved in the study to collect blood by heel prick for this purpose.
I understand that the data collected from the study will be strictly confidential.
Signature over Printed Name
Tel. No.: ________________
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