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INDIANA STATE DEPARTMENT OF HEALTH Local Liaison Office SCHOOL HEARING SCREENING REPORT State Form 39986 (R / 200) School Name School year of this report School Corporation Name of person completing
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How to fill out 39986pdf school hearing screening

01
Download the 39986pdf school hearing screening form from the official website or obtain a physical copy from the school or healthcare provider.
02
Read the instructions provided with the form to understand the requirements and process.
03
Fill in your personal information such as name, date of birth, and contact details in the designated fields.
04
Provide information about your school and grade level.
05
Answer the screening questions regarding your hearing health and any previous hearing screenings or issues.
06
If you have any known hearing problems or require accommodations, indicate them appropriately.
07
If necessary, provide additional documentation or medical reports that support your hearing needs or conditions.
08
Review the filled form carefully to ensure all the information is accurate and complete.
09
Sign and date the form as required.
10
Submit the completed form to the designated authority, such as your school nurse or healthcare provider.

Who needs 39986pdf school hearing screening?

01
Anyone attending a school that requires hearing screening may need to fill out the 39986pdf school hearing screening form.
02
This can include students of all grade levels, from elementary school to high school.
03
The purpose of the screening is to identify individuals with potential hearing difficulties and provide appropriate support or interventions.
04
Parents or guardians may also need to fill out the form on behalf of their child if they have a known hearing issue or require accommodations.
05
It is best to check with your school or healthcare provider to determine if you specifically need to complete this form.
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39986pdf school hearing screening is a standardized screening process conducted in schools to evaluate the hearing ability of students.
School administrators or healthcare professionals responsible for conducting the screening are required to file 39986pdf school hearing screening.
To fill out 39986pdf school hearing screening, the administrator or healthcare professional needs to document the results of the screening for each student, including any follow-up recommendations.
The purpose of 39986pdf school hearing screening is to identify students who may have hearing difficulties that could impact their academic performance.
Information such as student name, date of birth, screening date, screening results, and any recommendations for follow-up care must be reported on 39986pdf school hearing screening.
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