a procedure that carries a significant risk. Techniques Sample collection Newborn screening tests are most commonly done from whole blood samples collected on specially designed filter paper, originally designed by Robert Guthrie. The filter paper is often attached to a form containing required information about the infant and parents. This includes date and time of birth, date and time of sample collection, the infant's weight and gestational age. The form will also have information about whether the baby has had a blood transfusion and any additional nutrition the baby may have received (total parenteral nutrition). Most newborn screening cards also include contact information for the infant's physician in cases where follow up screening or treatment is needed. The Canadian province of Quebec performs newborn screening on whole blood samples collected as in most other jurisdictions, and also runs a voluntary urine screening program where parents collect a sample at 21 days of age and submit it to a provincial laboratory for an additional panel of conditions. Newborn screening samples are collected from the infant between 24 hours and 7 days after birth, and it is recommended that the infant has fed at least once. Individual jurisdictions will often have more specific requirements, with some states accepting samples collected at 12 hours, and others recommending to wait until 48 hours of life or later. Each laboratory will have its own criteria on when a sample is acceptable, or if another would need to be collected. Samples can be collected at the hospital, or by midwives. Samples are transported daily to the laboratory responsible for testing. In the United States and Canada, newborn screening is mandatory, with an option for parents to opt out of the screening in writing if they desire. In many regions, NBS is mandatory, with an option for parents to opt out in writing if they choose not to have their infant screened. In most of Europe, newborn screening is done with the consent of the parents. Proponents of mandatory screening claim that the test is for the benefit of the child, and that parents should not be able to opt out on their behalf. In regions that favour informed consent for the procedure, they report no increase in costs, no decrease in the number of children screened and no cases of included diseases in children who did not undergo screening. Laboratory testing Because newborn screening programs test