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Newborn Screening Ontario
Hearing Loss Risk Factor Screening

Forms

Risk Factor Screening for Permanent Hearing Loss - Requesting Testing for CMV and/or Genetic Risk Factors (GJB2/6, SLC26A4)

  • This requistion is to be used for result or test requests for babies who have confirmed PHL, suspected or confirmed CMV, or a personal/family history of genetic risk factors.
  • If risk factor screening was not performed for a child (e.g. they were born before July 29, 2019, or parent/guardian consent was not received), testing of the residual dried blood spot sample for CMV using PCR for viral DNA can be requested using this form.
  • For children with Permanent Hearing Loss and negative risk factor screening results, NSO can provide additional testing for CMV and genetic risk factors. This involves reporting whether or not a mutation was identified on the common mutation panel used for risk factor screening. If a sngle mutation was identified, full sequencing of the relevant gene can be performed by NSO.
  • Please call 613-738-3222 with any questions.