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COCHLEAR IMPLANT Audiology Referral Form Student Name:Date:Requested By: Educator Phone Number or Email: Equipment problem:Reason for referral (Check all that apply and provide specific examples or

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How to fill out cochlear implant audiology referral

01

Step 1: Gather all necessary patient information, including their personal and medical history.

02

Step 2: Conduct a comprehensive audiological evaluation to assess the patient's hearing abilities and determine their candidacy for a cochlear implant.

03

Step 3: Discuss the possible benefits and risks of cochlear implantation with the patient and their family.

04

Step 4: Complete the audiology referral form, ensuring that all sections are accurately and completely filled out.

05

Step 5: Attach any relevant test results, medical records, or supporting documentation to the referral form.

06

Step 6: Submit the completed audiology referral form to the appropriate medical professionals or organizations responsible for evaluating cochlear implant candidacy.

Who needs cochlear implant audiology referral?

01

Individuals who have severe to profound hearing loss and have not benefited from hearing aids may need a cochlear implant audiology referral.

02

Those who struggle to understand speech even with the use of hearing aids or experience difficulty in communicating with others due to their hearing loss may also benefit from a cochlear implant.

03

Cochlear implant audiology referral is typically required for both children and adults who meet the candidacy criteria for cochlear implantation, as determined through a thorough audiological evaluation.

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What is cochlear implant audiology referral?

Cochlear implant audiology referral is a process in which a patient with severe hearing loss is referred to an audiologist for evaluation and potential candidacy for a cochlear implant.

Who is required to file cochlear implant audiology referral?

The referral can be initiated by a variety of healthcare professionals, including ENT specialists, pediatricians, and primary care physicians.

How to fill out cochlear implant audiology referral?

To fill out a cochlear implant audiology referral, the healthcare professional must provide the patient's medical history, audiogram results, and rationale for considering a cochlear implant.

What is the purpose of cochlear implant audiology referral?

The purpose of the referral is to determine if a patient is a suitable candidate for a cochlear implant, which can help improve their hearing abilities significantly.

What information must be reported on cochlear implant audiology referral?

The referral should include the patient's medical history, recent audiogram results, reasons for considering a cochlear implant, and any relevant imaging studies.

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