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IN Hoosier Uplands Childrens Services Hearing Screening Report Form 2010-2025 free printable template

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Hoosier Uplands Children's Services Hearing Screening Report Form Child's name: DOB: HS Class/EHS HE: Audi OAE Test Frequency Right Ear Left Ear 2000KHz Screening Date: 3000 kHz 4000 kHz 5000 kHz
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How to fill out IN Hoosier Uplands Childrens Services Hearing Screening

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How to fill out IN Hoosier Uplands Childrens Services Hearing Screening Report

01
Obtain the IN Hoosier Uplands Childrens Services Hearing Screening Report form.
02
Fill in the child's personal information, including name, date of birth, and address.
03
Enter the date of the hearing screening.
04
Provide information about the child's medical history relevant to hearing.
05
Document the results of the hearing screening tests as per the instructions provided.
06
Include notes or comments regarding the child's behavior during the screening if necessary.
07
Sign and date the report to confirm the validity of the information provided.

Who needs IN Hoosier Uplands Childrens Services Hearing Screening Report?

01
Children who are undergoing routine health assessments.
02
Parents or guardians seeking to ensure their child's hearing health.
03
Healthcare providers monitoring children's developmental milestones.
04
Educational institutions needing documentation for enrollment assessments.
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The IN Hoosier Uplands Childrens Services Hearing Screening Report is a document used to record the hearing screening results of children enrolled in programs under the Hoosier Uplands Children's Services. It helps ensure that children receive necessary assessments and interventions for hearing-related issues.
The report is typically required to be filed by healthcare providers, educators, or professionals involved in the assessment of children's hearing as part of the early intervention and health screening processes.
To fill out the report, individuals must provide details such as the child's name, date of birth, screening results, the date of the screening, and any follow-up actions recommended based on the results.
The purpose of the report is to ensure early identification of hearing issues in children, facilitate timely interventions, and help in monitoring the hearing health of children within the Hoosier Uplands service area.
The report must include the child's personal information, the results of the hearing screening tests (pass or refer), the date of the screening, the name of the person conducting the screening, and any recommended follow-up actions.
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Relevant keywords

AuDX KHz Rescreen OAE R-052610 09mkm 2000KHz Childrens Childs EHS HV HS audiologist verbalize Hoosier Uplands DOB Referral enrolled inserted Administered

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