Click on your state below for the Destruction Form.  

If you have questions about the form or the blood spot retention practices, please contact your state's Department of Health.  

You may or may not have the option to request destruction of the blood spot, or the state may not make a form publicly available. Contact your department of health to ask about the blood spot retention practices and how you can ensure your baby's DNA sample is destroyed.

(*** page updated May 2020 - additional forms may be added as they become available***)

California Destruction Form

Indiana Destruction Form

Iowa Destruction Form

Maine Destruction Form

Michigan Destruction Form

Minnesota Destruction Form

Mississippi Blood Spot Request Form

Missouri Blood Spot Request Form

New York Destruction Form

North Dakota Blood Spot Request Form

Oregon Blood Spot Request Form

Pennsylvania Destruction Form

South Carolina Destruction Form

Texas Destruction Form After 6/1/2012**

Texas Destruction Form Before 6/1/2012**

Utah Destruction Form

Washington Destruction Form

** Date reflects time of collection of NBS bloodspot - NOT time of submitting a request

 

RETURN OF BLOOD SPOT TO PARENT FORM:

 

RESEARCH OPT-OUT:

Michigan Directive to Retain But Not Use DBS For Research

South Carolina Research Opt-Out Form

Note: the state cannot perform research on NBS bloodspots if you order them to be destroyed with one of the forms above. The forms in this section may be completed to allow storage of NBS blood spots with the state, but prohibit research from being performed on them.