Test Request Form (TRF)
Information about the newborn, recorded on the Test Request Form (TRF), is very important for the following reasons:
1. California averages 1,500 births a day. The demographics provide the means for locating a specific infant in order to obtain another specimen for testing whenever the initial specimen:
a) is initially positive,
b) is inadequate for testing, or
c) has an anomalous test pattern.
2. The patient information is used in reporting results to the hospitals and the physicians.
3. Information about a specimen, the birth weight, and transfusion status is used in evaluating the test results. (Note that the transfusion box should be marked "yes" if the newborn had an intrauterine transfusion.)
4. The physician's identity is essential to ensure timely tracking of the infant for follow-up testing and initiation of therapy for a newborn with one of these congenital conditions. The AAP has recommended every newborn have a medical home, i.e., a personal physician assigned at birth.
It is the responsibility of the pediatric provider to ensure the hospital has and is using current address, and that the physician listed on the form is the one providing care after discharge.
The top sheet of the Test Request Form (TRF) provides instructions for filling out the form. It is to be read and discarded.
The TRF should be completely filled out and the specimen collection card should be completed. The information on the specimen collection card MUST match the information on the TRF for a specimen to be considered adequate for testing. The newborn’s blood is collected on the specimen collection card. The barcode labels are peeled off the specimen collection card and applied to the TRF where indicated on the white and goldenrod copies.
The goldenrod copy is detached and remains in the birthing facility. It should be filed in the newborn’s chart. This copy is used for reference and/or tracking purposes and is an essential part of the review process that is conducted 14 days after the specimen is collected. When results are not yet in the newborn’s chart, the goldenrod copy can provide information to be used for tracking the specimen.
The white copy of the TRF, along with the specimen collection card, is sent to the facility's assigned Newborn and Prenatal Screening laboratory.
Completing the Demographic Information on the TRF
Accuracy and completeness of all the information provided about the newborn is very important for several reasons:
- The date and time of birth, birthweight, date and time of specimen collection, and information on transfusion status, are all critical for evaluating the newborn screening results.
- NBS results are sent to the physician of record as listed on the TRF. Incorrect or incomplete physician information delays or prevents receipt of the mailer or contacting the physician by phone, thereby potentially delaying timely follow-up.
- Should follow-up be needed on a newborn who has already been discharged, the newborn’s complete address is necessary for locating the infant.