Parentage Testing CF 5600 Rev 5/06
[pic] |Child Welfare Parentage Testing
and Division of Child Support Notification | |
|BOX 1 - Case Information |
|DHS Case: | | |DHS Contact: | |
|Schedule/Reschedule/Redraw: | |
|Mother: | |SS#: | / / | |
|City: | |State: | |Zip Code: | | |
|County: | |DOB: | / / |Race: | | |
| |DHS/LABCorp Comments: |
|Child: | |SS#: | / / | |
|City: | |State: | |Zip Code: | | |
|County: | |
|Alleged Father: | |SS#: | / / | |
|City: | |State: | |Zip Code: | | |
|County: | |DOB: | / / |Race: | | |
| | |
|Alleged Father: | |SS#: | / / | |
|City: | |State: | |Zip Code: | | |
|County: | |DOB: | / / |Race: | | |
| | |
|Box 2 – DCS Notification |
| Notification to DCS of Juvenile Court parentage action |
|Fax to: (503) 986-6289 - Lead worker/ Juvenile contact, State Recovery Central Unit (SRCU) |
|Voluntary acknowledgement attached Certified copy of court order of Paternity or Non-Paternity attached |
|Mail to: Lead worker / Juvenile Contact, State Recovery Central Unit (SRCU),1495 Edgewater Street, NW, Ste 120, Salem, OR 97302 |
|Phone: (503) 986-2501 |
|Box 3 – Authorization and Referral for Parentage Testing |
|Referral to LabCorp - Branch Account #: See page 2 county name & codes | Request for Funds Approved by: |
|Referral MUST BE FAXED TO: | |
|LabCorp: 1-800-821-9102 and Central Office (503) 378-3800 |____________________________ ___/____/____ |
|Court ordered? Yes No Juvenile Court #: |Signature Date |
|BRANCH ACCOUNT NUMBERS FOR BOX 3 SECTION |
| BAKER - 36300130" | MALHEUR - 36600070 |
|BENTON - 36200155" |MARION - Salem - 36200165 |
|CLACKAMAS-Milwaukie - 36101540 |MARION - Woodburn - 36230055 |
|CLACKAMAS-Oregon City - 36101545 |MORROW - 36700035 |
|CLATSOP - 36101535 |MULTNOMAH - East - 36110070 |
|COLUMBIA - 36101565 |MULTNOMAH - Gresham - 36100305 |
|COOS - 36400070 |MULTNOMAH - Hotline - 36101570 |
|CROOK - 36800075 |MULTNOMAH - Midtown - 36100250 |
|CURRY - 36500090 |MULTNOMAH - New Market - 36100815 |
|DESCHUTES - 36800030 |MULTNOMAH - North/Northeast - 36100255 |
|DOUGLAS - Reedsport - 36101665 |MULTNOMAH - Southeast - 36101585 |
|Douglas - Roseburg - 36110090 |MULTNOMAH - St. Johns - 36100285 |
|GILLIAM - |POLK - 36200135 |
|GRANT - 36700030 |SHERMAN - 36101675 |
|HARNEY - 36600055 |TILLAMOOK - 36101590 |
|HOOD RIVER - 36101670 |UMATILLA - Hermiston - 36700040 |
|JACKSON - 36500100 |UMATILLA - Pendleton - 36700025 |
|JEFFERSON - 36800080 |UNION - 36101595 |
|JOSEPHINE - 36500080 |WALLOWA - 36700020 |
|KLAMATH - 36600060 |WASCO - 36101625 |
|LAKE - 36610005 |WASHINGTON - Beaverton - 36600050 |
|LANE - Cottage Grove - 36300135 |WASHINGTON - Hillsboro - 36101630 |
|LANE - Eugene - 36300140 |WASHINGTON - Tigard - 36101640 |
|LANE - Springfield - 36300145 |WHEELER - |
|LINCOLN - 36200160 |YAMHILL-McMinnville - 36200170" |
|LINN - 36200175 |YAMHILL-Newberg - 362001 |
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