Canada BC Childrens Hospital Audiology Referral 2010 free printable template

Audiology and Speech Language Pathology Department REFERRAL FORM Phone: 604-875-2112 SPEECH AND LANGUAGE ASSESSMENT: **IMPORTANT** FOR SPEECH/LANGUAGE REFERRALS IN ORDER TO FACILITATE THE INTAKE PROCESS,

How to fill out Canada BC Childrens Hospital Audiology Referral

How to fill out Canada BC Childrens Hospital Audiology Referral

1. Obtain the Audiology Referral Form from the Canada BC Children's Hospital website or your local healthcare provider.
2. Fill out the patient's personal information including name, date of birth, and contact details.
3. Provide relevant medical history, specifically any hearing concerns or related conditions.
4. Indicate the reason for the referral, such as developmental delays or hearing loss symptoms.
5. Include the names of any healthcare professionals who are referring the patient.
6. Ensure that all sections of the form are completed accurately and clearly.
7. Sign and date the form to validate the referral.
8. Submit the completed form via the specified method (mail, fax, or online portal) as indicated by the hospital instructions.

Who needs Canada BC Childrens Hospital Audiology Referral?

1. Children who exhibit signs of hearing loss or difficulty in communication.
2. Patients with developmental delays that might affect their auditory processing.
3. Children referred by their pediatricians or family doctors due to concerns about hearing.
4. Individuals requiring evaluation for hearing aids or other auditory aids.

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What is Canada BC Childrens Hospital Audiology Referral?

The Canada BC Children's Hospital Audiology Referral is a process for referring children in need of audiological assessment and services to the specialized audiology department at BC Children's Hospital.

Who is required to file Canada BC Childrens Hospital Audiology Referral?

Referrals are typically filed by healthcare professionals such as pediatricians, family doctors, or audiologists who identify the need for audiological evaluation in a child.

How to fill out Canada BC Childrens Hospital Audiology Referral?

To fill out the referral, healthcare providers must complete a standardized form that includes the child's personal information, medical history, reason for referral, and any relevant assessments or previous audiological results.

What is the purpose of Canada BC Childrens Hospital Audiology Referral?

The purpose of the referral is to ensure that children who may have hearing loss or related concerns receive appropriate evaluation, diagnosis, and treatment from specialized audiology professionals.

What information must be reported on Canada BC Childrens Hospital Audiology Referral?

The referral must include the child's full name, date of birth, contact information, reason for referral, medical history, any relevant assessments, and the referring clinician's contact details.