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REFERRAL AND TRACKING FORM ARIZONA EARLY HEARING DETECTION AND INTERVENTION ARIZONA STATE SCHOOLS FOR THE DEAF AND THE BLIND PHOENIX PLEASE FAX WITH ASSESSMENT RESULTS WITHIN 48 HOURS TO ASDB fax 602-544-1704 phone 602-771-5200 AzEHDI fax 602-364-1495 phone 602-364-1409 NAME OF CHILD CHILD BIRTH DATE DATE REFERRED BIRTH HOSPITAL MALE MOTHER S FULL NAME FEMALE MOTHER BIRTHDATE ADDRESS WITH CITY ZIP PRIMARY PERSON TO CONTACT CELL PHONE HOME PHONE W...

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What is arizona early hearing detection?

Arizona early hearing detection is a program aimed at identifying hearing loss in infants and young children in the state of Arizona.

Who is required to file arizona early hearing detection?

Healthcare providers who conduct hearing screenings on infants and young children in Arizona are required to file arizona early hearing detection.

How to fill out arizona early hearing detection?

The arizona early hearing detection form can be filled out online or submitted by mail. Healthcare providers must enter the required information about the hearing screening conducted on the infant or young child.

What is the purpose of arizona early hearing detection?

The purpose of arizona early hearing detection is to ensure early identification of hearing loss in infants and young children, which allows for early intervention and treatment to improve their communication and developmental outcomes.

What information must be reported on arizona early hearing detection?

The arizona early hearing detection form requires healthcare providers to report the infant or young child's demographic information, the date and results of the hearing screening, as well as any referral for further evaluation or treatment if hearing loss is detected.

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