***This HTML is created using a transform which is provided on an as is basis, and the content of this HTML is not clinically validated. The transform used to create this HTML can be modified as per local needs.***

Patient demographics
NHS number | Other identifier
SMITH, Mark | 28-Jul-2012 | Male | Unverified - 993 254 1280 [Trace needs to be resolved] | Local identifier - K12345

Home Address Appleton House Lanchester Road Grimsby DN3 1UJ |
GP Practice
Dr De Hopper and Partners
| Address Freshney Green PCC Grimsby DN34 4GB | Phone 01634111222
GP Practice Code V396F

Document Created | 11-Sep-2012, 14:00
Document Owner | LEEDS TEACHING HOSPITALS NHS TRUST
Authored by | Ms Niral Singh - Midwife - Specialist Practitioner, St James Hospital on 11-Sep-2012, 14:00

Child Screening Report

#

Mother Details

NHS Number | 9932541276
Name | Mrs Shelly Smith
Address | Appleton House Lanchester Road Grimsby DN3 1UJ

#

Newborn Birth Details

Gestational age | 40 Weeks
Birth order | 01
Number of births in confinement | 1
Birth weight | 2887 grams

#

NewBorn Hearing Screening Test

Children's hearing test
Results | 11-Sep-2012 14:30 | Hearing screening programme completed, no clear response in one ear, follow-up required
Referral | 15-Sep-2012 14:30 | Referral for audiology

#

Blood Spot Screening

Phenylketonuria screening test
Results | Not screened/screening incomplete
Result Interpretation | Re-evaluated Result: Laboratory Confirm as Correct
Screening Sub Status | Not contactable, reasonable efforts made
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Sickle cell disease screening test
Results | Not screened/screening incomplete
Screening Sub Status | Not contactable, reasonable efforts made
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Cystic fibrosis screening test
Results | Repeat / Further sample required
Result Interpretation | Re-evaluated Result: Laboratory Confirm as Correct
Screening Sub Status | Too soon after transfusion (less than 72 hours)
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Congenital hypothyroidism screening test
Results | Not screened/screening incomplete
Screening Sub Status | Not contactable, reasonable efforts made
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Medium-chain acyl-coenzyme A dehydrogenase deficiency screening test
Results | Not screened/screening incomplete
Screening Sub Status | Not contactable, reasonable efforts made
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Maple syrup urine disease screening test
Results | Repeat / Further sample required
Result Interpretation | Re-evaluated Result: Laboratory Confirm as Correct
Screening Sub Status | Unsuitable sample
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Homocystinuria screening test
Results | Repeat / Further sample required
Result Interpretation | Re-evaluated Result: Laboratory Confirm as Correct
Screening Sub Status | Insufficient sample
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Isovaleric acidaemia screening test
Results | Repeat / Further sample required
Result Interpretation | Re-evaluated Result: Laboratory Confirm as Correct
Screening Sub Status | Unsuitable sample
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife
Glutaric aciduria type 1 screening test
Results | Repeat / Further sample required
Result Interpretation | Re-evaluated Result: Laboratory Confirm as Correct
Screening Sub Status | Insufficient sample
Reason Text | Newborn blood spot sampling
Supplementary Text | Performed by midwife

#

Newborn Physical Examination

Newborn and Infant Physical Examination Screening Programme, hip examination | Incomplete
Newborn and Infant Physical Examination Screening Programme, heart examination | No abnormalities with risk factors
Newborn and Infant Physical Examination Screening Programme, eye examination | Unilateral abnormality suspected (Left) with risk factors
Newborn and Infant Physical Examination Screening Programme, testis examination | Bi-lateral abnormality suspected

## Laboratory Details

St James Pathology Laboratory

### Date of Receipt at Lab

11-Sep-2012, 13:10

### Lab Card Serial Number

0902652801

### Previous Lab Card Serial Number

0902652800

## Specimen Collection Details

Blood specimen collected at St. James Hospital

### Specimen Collection Time

11-Sep-2012, 13:00

### Specimen Collected by

Mr Brian Weberly