Get the free Referral Form for Infant Hearing Program
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This form is used to refer infants for hearing assessments based on specific criteria and consent requirements from parents or guardians.
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How to fill out referral form for infant
How to fill out Referral Form for Infant Hearing Program
01
Obtain the Referral Form for the Infant Hearing Program from the relevant health authority or program website.
02
Fill out the infant's basic information, including name, date of birth, and contact details.
03
Provide details about the referring physician or clinician, including their contact information.
04
Indicate the reasons for the referral, highlighting any specific concerns regarding the infant's hearing.
05
Include any relevant medical history or significant health information related to the infant's hearing.
06
Review the completed form for accuracy and completeness.
07
Submit the Referral Form according to the instructions provided, either via mail, fax, or online submission.
Who needs Referral Form for Infant Hearing Program?
01
Infants who have been identified with potential hearing loss or who are at risk for hearing issues.
02
Parents or guardians of infants who have concerns regarding their child's hearing development.
03
Healthcare providers who are conducting routine screenings or assessments and need to refer a child for further evaluation.
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People Also Ask about
What does "referred" mean on a newborn hearing test?
Refer: This means your baby's hearing in one or both ears did not respond as expected and further testing is needed. This does not mean your baby has a confirmed hearing loss. Many conditions, including fluid in the ears that may resolve within the weeks after birth, may cause a “refer” on a hearing screen.
What is the pass rate for the newborn hearing screening?
Between 2 and 10 percent of all babies across the United States do not pass their first hearing screen, but very few of these babies have permanent hearing loss. Babies can fail the newborn hearing screening due to vernix in the ear canal, fluid in the middle ear, or because of movement or crying during the test.
What is the 1/3/6 rule in infant hearing screening?
Recommended Early Hearing Detection and Intervention (EHDI) benchmarks include screening for hearing loss before 1 month of age, diagnostic evaluation before 3 months of age, and enrollment in early intervention before 6 months of age, known as the 1-3-6 benchmarks.
What is the referral rate for newborn hearing screening?
the percentage of newborns who complete hearing screening (inpatient and outpatient) by 1 month of age — benchmark of more than 95% the percentage of newborns referred for diagnostic audiologic evaluation — benchmark of less than 4%
How much does a newborn hearing screening coordinator make?
An entry level newborn hearing screening program coordinator (1-3 years of experience) earns an average salary of $64,637.
What is the pass rate for the newborn hearing screening?
Between 2 and 10 percent of all babies across the United States do not pass their first hearing screen, but very few of these babies have permanent hearing loss. Babies can fail the newborn hearing screening due to vernix in the ear canal, fluid in the middle ear, or because of movement or crying during the test.
What does refer mean on a newborn hearing test?
Non-Pass/Refer: This means that further testing is needed to confirm your child's hearing ability. If your baby gets a Non-Pass/Refer result, please do not be alarmed.
How many states require newborn hearing screening?
Now all 50 states and the District of Columbia have newborn screening laws or voluntary compliance programs, and over 98% of infants are tested; before 1993, fewer than 1 in 10 newborns in the U.S. were screened.
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What is Referral Form for Infant Hearing Program?
The Referral Form for Infant Hearing Program is a document used to initiate screening and services for infants who may have hearing loss or are at risk for hearing impairment.
Who is required to file Referral Form for Infant Hearing Program?
Healthcare providers, such as pediatricians and audiologists, are required to file the Referral Form for infants who did not pass initial hearing screenings or are identified as being at risk for hearing loss.
How to fill out Referral Form for Infant Hearing Program?
To fill out the Referral Form for Infant Hearing Program, provide the infant's demographic information, screening results, risk factors, and the reason for referral, ensuring all fields are completed accurately.
What is the purpose of Referral Form for Infant Hearing Program?
The purpose of the Referral Form for Infant Hearing Program is to ensure that infants identified with potential hearing issues receive timely assessment and appropriate interventions.
What information must be reported on Referral Form for Infant Hearing Program?
The information that must be reported includes the infant's name, date of birth, screening results, any identified risk factors for hearing loss, and the contact details of the healthcare provider initiating the referral.
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