Canada CHEO Audiology Referral Form Hearing Assessment for Children 2016 free printable template

(For office use only) Date received stamp AUDIOLOGY REFERRAL FORM Hearing Assessment for Children Date of Referral (dd/mm/YYY): PLEASE PRINT. Please complete all sections of this form. Incomplete

How to fill out Canada CHEO Audiology Referral Form Hearing

How to fill out Canada CHEO Audiology Referral Form Hearing Assessment

1. Obtain the Canada CHEO Audiology Referral Form from the official CHEO website or your healthcare provider.
2. Fill in the patient's personal information, including name, date of birth, and contact details.
3. Provide details of the referring physician, including their name, contact number, and clinic address.
4. Complete the medical history section, noting any relevant health issues, hearing concerns, or previous audiological assessments.
5. Indicate any specific concerns or reasons for the referral in the designated section.
6. Ensure that all required fields are filled out completely and accurately.
7. Sign and date the form to confirm the information provided is correct.
8. Submit the completed referral form to the CHEO Audiology department via fax or email as instructed.

Who needs Canada CHEO Audiology Referral Form Hearing Assessment?

1. Children experiencing hearing difficulties or delays in speech development.
2. Patients with a history of ear infections or fluid buildup in the ears.
3. Those who have been recommended for an audiological assessment by a primary care provider or specialist.
4. Children undergoing other medical evaluations where hearing assessment is pertinent.

People Also Ask about

What is the difference between an ear doctor and an audiologist?

Although audiologists and ENT doctors often deal with similar problems, an ENT doctor deals with more advanced medical issues while an audiologist is an expert in diagnosing hearing loss and using technological solutions to help you manage it and live with it.

How do you get referred to an audiologist?

A GP may refer you to a hearing specialist (audiologist) who can do the test. It could take a few weeks to see a specialist so it might be quicker to get tested somewhere else, like at a large pharmacy or opticians. This is often free.

When would you refer a client to an audiologist?

History of sudden or rapidly progressing hearing loss within the previous 90 days (FDA, 1977) or within the previous six months (AAO-HNS, 1993, 1994). Acute or chronic dizziness (FDA, 1977) or recurrent episodes of dizziness (AAO-HNS, 2015).

How do I get a referral to an audiologist?

A GP may refer you to a hearing specialist (audiologist) who can do the test. It could take a few weeks to see a specialist so it might be quicker to get tested somewhere else, like at a large pharmacy or opticians.

What is an audiology appointment for?

An adult hearing assessment appointment may take between 45 minutes to 1 hour. The audiologist will take a medical history and ask you about your hearing in different situations. The audiologist will check your ears for wax, infections or any other abnormalities. Tympanometry may be performed after the hearing test.

What are normal child hearing test results?

The normal hearing range for children is -10 to 15 dB at all frequencies (0 to 20 dB when testing babies through the speakers). Parents of children might not realize they need to get their children hearing tests and they just assume they are hearing in the normal range.

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What is Canada CHEO Audiology Referral Form Hearing Assessment?

The Canada CHEO Audiology Referral Form Hearing Assessment is a document used to refer patients for audiological evaluation and diagnostic services at the Children's Hospital of Eastern Ontario (CHEO).

Who is required to file Canada CHEO Audiology Referral Form Hearing Assessment?

Healthcare professionals, such as pediatricians, general practitioners, or specialists, are required to file the Canada CHEO Audiology Referral Form Hearing Assessment on behalf of the patient.

How to fill out Canada CHEO Audiology Referral Form Hearing Assessment?

To fill out the Canada CHEO Audiology Referral Form Hearing Assessment, the referring professional must complete patient demographic information, reason for referral, relevant medical history, and any preliminary findings related to hearing issues.

What is the purpose of Canada CHEO Audiology Referral Form Hearing Assessment?

The purpose of the Canada CHEO Audiology Referral Form Hearing Assessment is to ensure that patients receive appropriate hearing assessments to identify any potential hearing impairments and to guide further intervention and management.

What information must be reported on Canada CHEO Audiology Referral Form Hearing Assessment?

The information that must be reported includes patient details (name, date of birth, and contact information), reason for referral, medical history related to hearing concerns, and any previous audiological evaluations.