*Hospitals and primary care providers in Pennsylvania must obtain all screening results from nbs.pa.gov
I certify under penalty of law that I am accessing MY OWN birth record information, or I have written authorization from the record holder to access the requested information, and that all information contained herein is true and correct. I understand that any misstatement of fact is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year (18 PA. C.S. Section 4904(b))
For questions on form completion please call 717-783-8143 or email RA-TCNBSAdmin_Fax@pa.gov