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This document is used for notifying parents/guardians about the results of their child's hearing screening and to provide a referral for further examination by a physician if needed.
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How to fill out Burrell School District Hearing Screening Referral

01
Obtain the Burrell School District Hearing Screening Referral form from the school office or website.
02
Fill in the student's personal information, including name, date of birth, and grade level.
03
Indicate the reason for the referral, such as concerns about hearing or previous screening results.
04
Provide details on any specific symptoms observed, if applicable.
05
Sign and date the form where indicated.
06
Submit the completed form to the school nurse or designated office.

Who needs Burrell School District Hearing Screening Referral?

01
Students who exhibit signs of hearing difficulties or have been reported to have hearing issues.
02
Students who did not pass the initial hearing screening in school.
03
Students with a history of ear infections or auditory processing issues.
04
Students who are new to the district and need to establish hearing health records.
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The Burrell School District Hearing Screening Referral is a formal process used to identify and refer students who may have hearing issues that require further evaluation.
Typically, school nurses, teachers, or other educational staff who notice potential hearing problems in students are required to file the Burrell School District Hearing Screening Referral.
To fill out the referral, you will need to complete the designated form, providing student information, details of the observed hearing issues, and any relevant medical history.
The purpose of the referral is to ensure that students with potential hearing problems are evaluated by qualified professionals to address any issues that could affect their learning.
The information that must be reported includes student’s name, date of birth, the nature of hearing problems observed, the results of any preliminary screenings, and recommendations for further evaluation.
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