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Newborn Screening Ontario
Hearing Loss Risk Factor Screening

Forms

This page includes forms commonly used by health care providers. Please contact us if you would like to make a request and require direction as to which form to use. 

Requisition for CMV Testing on a Residual Dried Blood Spot Sample - Testing of the residual dried blood spot sample for CMV can be requested from NSO for all children 19 years of age or under using PCR for viral DNA. 

Risk Factor Screening for Permanent Hearing Loss - Requisition for Additional Interpretation and Testing - Coming Soon! - For children with Permanent Hearing Loss and negative risk factor screening results, NSO can provide additional interpretation and testing.  This involves reporting whether or not a mutation was identified on the screening panel. If one mutation was identified, a health care provider can request NSO perform sequencing of that gene to look for a second mutation before you consider extended panel testing.  If no mutations are identified on the screening panel, NSO will not offer gene sequencing and additional genetic testing should be considered according to you clinical practice.