Get the free Hearing Screening and Follow-up Survey (HSFS)*

OMB No. 09200733 Exp. Date: 8/31/20162014 CDC EDI Hearing Screening and Followup Survey (HFS)* Contact Information Name Email Confirm Email State/TerritoryNote: Please select the Type and Severity

How to fill out hearing screening and follow-up

1. Make sure to gather the necessary forms and documents needed for the hearing screening and follow-up. These may include any medical history reports, referral forms, or consent forms provided by the healthcare provider.
2. Fill out personal information accurately and completely. This generally includes your full name, date of birth, contact information, and any other relevant demographic details requested.
3. Provide details about any previous hearing tests or screenings you have undergone. If you have any hearing devices or aids, make sure to include details about them as well.
4. Be prepared to answer questions about your medical history, including any previous or current conditions that may affect your hearing. This could include issues such as ear infections, noise exposure, or any genetic hearing conditions.
5. Include information about any medications you are taking, as certain medications can have an impact on hearing health.
6. Be honest and thorough when answering questions about your hearing health symptoms. This may include details about any hearing loss, tinnitus (ringing in the ears), or balance problems you have experienced.
7. If the screening or follow-up specifically relates to a certain event or exposure, provide all relevant details. For example, if it is related to workplace noise exposure, include information about your job, hours of exposure, and any protective measures in place.
8. After completing the hearing screening and follow-up form, make sure to review it for accuracy and completeness before submitting it to the healthcare provider.

Who needs hearing screening and follow-up?

1. Individuals who are experiencing hearing loss or noticing changes in their hearing ability.
2. Individuals at risk of hearing loss due to noise exposure, such as those working in loud environments or participating in activities with high noise levels.
3. Babies and young children who may have issues with their hearing development.
4. Individuals with a family history of hearing loss or genetic conditions that may affect hearing.
5. Individuals with certain medical conditions or taking medications known to impact hearing health.
6. Individuals who have experienced certain medical events or traumas that may have affected their hearing.
7. Anyone who is concerned about their hearing health and wants to ensure their overall well-being.

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What is hearing screening and follow-up?

Hearing screening is a test to check how well a person is able to hear. Follow-up refers to any additional tests or interventions that may be needed based on the screening results.

Who is required to file hearing screening and follow-up?

Healthcare professionals, schools, and other institutions may be required to file hearing screening and follow-up reports as mandated by state or local regulations.

How to fill out hearing screening and follow-up?

Hearing screening and follow-up forms typically require information such as patient demographics, screening results, follow-up recommendations, and provider details.

What is the purpose of hearing screening and follow-up?

The purpose of hearing screening and follow-up is to identify potential hearing issues early on and provide appropriate interventions to prevent further complications.

What information must be reported on hearing screening and follow-up?

Information such as patient demographics, screening results, follow-up recommendations, and provider details must be reported on hearing screening and follow-up forms.