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Pediatric Cochlear Implant Referral & Criteria Form (0 to 19 years) To ensure your referral is accepted and actioned immediately, it is vital that we receive the complete information requested below.
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How to fill out paediatric cochlear implant referral

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How to fill out paediatric cochlear implant referral

01
Step 1: Obtain the paediatric cochlear implant referral form from the referring healthcare professional.
02
Step 2: Fill out the patient's personal information including name, date of birth, and contact information.
03
Step 3: Provide details about the patient's medical history and any previous hearing interventions.
04
Step 4: Include information about the child's current hearing abilities and any difficulties experienced.
05
Step 5: Describe the results of any relevant audiological assessments or tests.
06
Step 6: Indicate the reason for the referral and the desired outcome of the cochlear implantation.
07
Step 7: Provide any additional information or relevant documents that may support the referral.
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Step 8: Sign and date the referral form before submitting it to the appropriate cochlear implant center.

Who needs paediatric cochlear implant referral?

01
Children with severe to profound hearing loss who do not benefit sufficiently from conventional hearing aids may require a paediatric cochlear implant referral.
02
Candidates for paediatric cochlear implants are typically children between the ages of 9 months and 18 years who have been evaluated by an audiologist and determined to be eligible for the procedure.
03
This referral is necessary for children who may benefit from the advanced hearing technology provided by cochlear implants to improve their hearing abilities and overall quality of life.
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Paediatric cochlear implant referral is a process by which a child is referred for evaluation for a cochlear implant to help with hearing loss.
A healthcare provider such as an audiologist or ENT specialist is usually responsible for filing the paediatric cochlear implant referral.
The referral form can be filled out by the healthcare provider with the child's medical history, hearing test results, and other relevant information.
The purpose of paediatric cochlear implant referral is to determine if a child is a candidate for a cochlear implant and to start the evaluation process.
The referral must include the child's medical history, hearing test results, and any other relevant medical information.
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