Canada CHEO Audiology Referral Form Hearing Assessment for Children 2019-2025 free printable template

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

How to fill out hearing assessment for children

How to fill out Canada CHEO Audiology Referral Form Hearing Assessment

1. Obtain the Canada CHEO Audiology Referral Form from the CHEO website or your healthcare provider.
2. Fill out the patient's personal information including name, date of birth, and contact details.
3. Provide information about the referring physician, including their name, contact information, and address.
4. Indicate the reason for the referral by checking relevant boxes or providing a detailed explanation of the patient's symptoms or concerns.
5. Include any relevant medical history or previous audiological assessments that may be pertinent to the referral.
6. Sign and date the form to confirm the accuracy of the information provided.
7. Submit the completed form to the appropriate CHEO audiology department via email, fax, or postal service as indicated on the form.

Who needs Canada CHEO Audiology Referral Form Hearing Assessment?

1. Children experiencing hearing difficulties or concerns about their auditory processing.
2. Patients with a history of ear infections or other otological conditions that may affect hearing.
3. Individuals referred by a healthcare provider for specialized audiological assessment.
4. Children who have missed developmental hearing milestones or exhibit signs of hearing loss.

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 at the Children's Hospital of Eastern Ontario (CHEO). It facilitates the process of assessing hearing abilities in children.

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

The referral form is typically required to be filed by healthcare professionals such as pediatricians, family doctors, or specialists who identify a need for hearing assessment in a child.

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

To fill out the form, the healthcare provider must complete sections detailing the child's personal information, medical history, any relevant test results, and specific concerns or reasons for the referral.

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

The purpose of the form is to ensure timely and appropriate audiological evaluation for children suspected of having hearing problems, allowing for early intervention and management.

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

The form must include the child's demographic information, a brief medical history, the referring provider's contact details, specific concerns related to hearing, and any previous audiological assessments if available.