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SEATTLE HEARING AND BALANCE CENTER 1600 EAST JEFFERSON #202 SEATTLE, WA 98122 (206) 3205687 Pediatric Hearing History Patient Name: Gender: DOB: Person completing form: Relation to patient: Today's
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How to fill out pediatric hearing history

01
Gather all the necessary information about the child's medical and hearing history.
02
Include details about any past or present ear infections or surgeries the child has undergone.
03
Document any family history of hearing impairment or disorders.
04
Note down milestones in the child's language and speech development.
05
Include information about any medications or treatments the child is currently undergoing.
06
Ask the child's parents or guardians about any concerns or observations regarding the child's hearing abilities.
07
Record any additional relevant information that might help in assessing the child's hearing health.

Who needs pediatric hearing history?

01
Pediatricians and other healthcare professionals who regularly provide care to children.
02
Audiologists and hearing specialists who evaluate and treat children with hearing difficulties.
03
Parents or caregivers of children with possible hearing impairments or disorders.
04
Schools and educational institutions that require hearing history documentation for admission purposes.
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Pediatric hearing history refers to the documented record of a child's hearing health, including any concerns, tests, treatments, and results related to their ability to hear.
Parents or legal guardians of children are typically required to file pediatric hearing history forms with healthcare providers or educational institutions.
Parents can fill out pediatric hearing history forms by providing accurate information about their child's hearing health, including any history of ear infections, hearing loss, or other related issues.
The purpose of pediatric hearing history is to help healthcare providers and educators better understand a child's hearing health and provide appropriate care or accommodations as needed.
Information such as previous ear infections, hearing screenings, test results, family history of hearing loss, and any interventions or treatments should be reported on pediatric hearing history forms.
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