Get the free MNHP Hearing Screening Referral Form - Maine.gov

Population Health Management Programmer Management Referral Form Date: Referral Requestor: Requestor Contact #: PCP Name: Patient Name: Payer ID#: Patient Phone #: Primary Language: Legal Guardian

How to fill out mnhp hearing screening referral

How to fill out mnhp hearing screening referral

1. Obtain the MNHP hearing screening referral form from the concerned healthcare provider.
2. Read the instructions provided on the form carefully.
3. Fill out the patient's personal information accurately, including their full name, date of birth, address, and contact details.
4. Provide the patient's medical history related to hearing screenings and any existing hearing conditions or concerns.
5. Clearly state the reason for referral, whether it is for a routine hearing screening or follow-up assessment.
6. Indicate any additional information or special instructions that may be relevant for the hearing screening provider.
7. Review the completed form for any errors or missing information before submitting it.
8. Submit the filled-out MNHP hearing screening referral form to the designated authority or healthcare provider for further processing.

Who needs mnhp hearing screening referral?

1. Any individual who requires a hearing screening or follow-up assessment as recommended by their healthcare provider.
2. Individuals who have experienced hearing-related symptoms, such as difficulty hearing, ringing in the ears, or frequent ear infections.
3. Children who have not passed initial hearing screenings or have been identified as being at risk for hearing impairments.
4. Individuals with known or suspected hearing loss or hearing impairments.
5. Patients referred by physicians, audiologists, or other healthcare professionals for further evaluation of their hearing health.

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What is mnhp hearing screening referral?

MNHP hearing screening referral is a formal request to assess an individual's hearing ability after initial screening indicates a potential hearing issue.

Who is required to file mnhp hearing screening referral?

Healthcare providers, including audiologists and pediatricians, are required to file MNHP hearing screening referrals for patients who do not pass the initial hearing screening.

How to fill out mnhp hearing screening referral?

To fill out the MNHP hearing screening referral, complete the required fields with patient information, details of the initial screening, and any relevant medical history before submitting it to the appropriate audiology service.

What is the purpose of mnhp hearing screening referral?

The purpose of the MNHP hearing screening referral is to ensure individuals who may have hearing issues receive further assessment and appropriate interventions in a timely manner.

What information must be reported on mnhp hearing screening referral?

The information that must be reported includes the patient’s personal details, results of the hearing screening, dates of tests, and any pertinent medical history or risk factors.