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PHYSICIANS HEARING SERVICES Central California Ear Nose and Throat 1351 E. Spruce, Suite #130, Fresno, CA 93720 PHONE: (559)432-5973 FAX: (559)432-0615 SPECIAL TESTING / REFERRAL REQUEST FORM Patient

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How to fill out special testing audiology referral

01

Start by gathering all the necessary information. You will need the patient's name, contact information, and medical history, including any relevant symptoms or complaints they may have.

02

Next, indicate the reason for the referral. This could be a specific concern like hearing loss, tinnitus, or balance issues. It is important to provide detailed information to help the audiologist understand the specific problem the patient is facing.

03

Make sure to include any previous tests or evaluations that have been conducted related to the patient's hearing or balance. This may include audiograms, tympanograms, or any other relevant test results.

04

Specify any medications the patient is currently taking, as well as any known allergies or medical conditions that may affect their audiological evaluation or treatment.

05

Indicate if the referral is urgent or if the patient has any preference for a particular audiologist or clinic. If the referral is urgent, it is important to clearly state the reason and any supporting documentation that necessitates immediate attention.

06

Finally, include any additional comments or concerns that you deem necessary for the audiologist to be aware of. These could include specific questions, concerns about potential genetic factors, or any other relevant information that may aid in the evaluation and treatment process.

Special audiology testing referral is typically needed for individuals who are experiencing a specific concern related to their hearing, balance, or any other related issues. It may be required for patients who have reported symptoms such as difficulty hearing, ringing in the ears, vertigo, or any other condition that may require specialized testing. This referral is usually made by a primary care physician or another healthcare professional who has identified the need for further evaluation and treatment by an audiologist.

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What is special testing audiology referral?

Special testing audiology referral is a process by which individuals are referred to undergo specialized hearing tests to evaluate their auditory health.

Who is required to file special testing audiology referral?

Special testing audiology referral must be filed by healthcare providers such as physicians, audiologists, or other medical professionals.

How to fill out special testing audiology referral?

Special testing audiology referral can be filled out by providing the patient's personal information, reason for referral, and any relevant medical history.

What is the purpose of special testing audiology referral?

The purpose of special testing audiology referral is to ensure that individuals receive appropriate testing to assess their hearing abilities and identify any potential auditory issues.

What information must be reported on special testing audiology referral?

Information such as patient's name, contact information, referring physician, reason for referral, insurance details, and any relevant medical history must be reported on special testing audiology referral.

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