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California State University, Fresno Speech, Language and Hearing Clinic 5310 North Campus Drive M/S PH 80 Fresno, California 937408019 (559) 2782422 Fax (559) 2785187 CHILD CASE HISTORY PLEASE PRINT
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How to fill out speech language and hearing:

01
Gather necessary information: Begin by collecting all relevant information such as personal details, medical history, and any previous assessments or reports related to speech, language, or hearing concerns.
02
Complete the individual's details: Fill out the required fields with the person's full name, date of birth, contact information, and any other requested demographic data.
03
Provide a detailed description of concerns: Clearly articulate the specific issues or concerns related to speech, language, or hearing that the individual is experiencing. Include any relevant information about the onset of symptoms, their severity, and how they impact daily life.
04
Mention any previous assessments or interventions: If the individual has previously undergone any evaluations or interventions related to speech, language, or hearing, provide a summary of those experiences. Include details such as the date, the professionals involved, and the outcomes or recommendations that resulted from those interventions.
05
Include relevant medical history: Fill out any sections related to the person's medical history, including past or current medical conditions, medications being taken, and any relevant surgeries or procedures.
06
Provide contact information for primary healthcare providers: Include the names and contact details of the individual's primary care physician, audiologist, speech-language pathologist, or any other professionals involved in their care.

Who needs speech language and hearing:

01
Infants and children with speech or language delays: Children who are not meeting typical speech and language milestones may benefit from speech-language pathology services to support their communication development.
02
Individuals with hearing loss: People of all ages who experience hearing loss may need speech-language pathology and audiology services to address their communication challenges and provide appropriate interventions such as hearing aids or cochlear implants.
03
Individuals with speech and language disorders: Those who have difficulties producing speech sounds, understanding language, expressing themselves, or utilizing language in social contexts may require speech-language pathology services to improve their communication skills.
04
People with swallowing or feeding difficulties: Speech-language pathologists are also well-equipped to assess and treat swallowing and feeding disorders, which can be particularly crucial for individuals with medical conditions or injuries that affect these functions.
05
Those with cognitive-communication impairments: Individuals who have cognitive impairments resulting from conditions such as traumatic brain injury, stroke, or dementia may benefit from speech-language pathology services to address their communication challenges and help improve their overall quality of life.
In summary, filling out a speech language and hearing form involves gathering necessary information, providing a detailed description of concerns, mentioning any previous assessments or interventions, and including relevant medical history. Speech language and hearing services are essential for infants, children, individuals with hearing loss, speech and language disorders, swallowing or feeding difficulties, and cognitive-communication impairments.
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Speech language and hearing refers to the evaluation and treatment of communication disorders and hearing loss.
Speech language pathologists and audiologists are required to file speech language and hearing reports.
Speech language and hearing reports can be filled out electronically or manually, following the specific guidelines provided by the regulatory bodies.
The purpose of speech language and hearing reports is to document the evaluation, treatment, progress, and outcomes of individuals with communication disorders and hearing loss.
Information regarding the assessment, diagnosis, treatment plan, progress notes, and outcome measures must be reported on speech language and hearing forms.
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