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HS0065 Rev. 11/17HEARING REFERRAL LETTER Health Services Department Lincoln Public Schoolmate: ___ To the Parent/Guardian of: ___ A hearing screening has been completed as part of the School Health

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How to fill out wwwlpsorgappsformshearing referral letter health

01

Download the referral letter form from www.lps.org/apps/forms/hearing-referral-letter-health.

02

Fill out the form with the required information.

03

Provide your contact information, including your name, phone number, and email address.

04

Specify the reason for the referral and any relevant medical history.

05

Include any supporting documents or test results that may be helpful for the assessment.

06

Sign and date the form.

07

Submit the completed form either in person or by mail to the appropriate recipient.

Who needs wwwlpsorgappsformshearing referral letter health?

01

Individuals who require a hearing assessment or evaluation by a healthcare professional.

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wwwlpsorgappsformshearing referral letter health is a form used to refer individuals for a hearing health evaluation.

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Healthcare providers and professionals are required to file wwwlpsorgappsformshearing referral letter health when referring a patient for a hearing evaluation.

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Information such as patient demographics, medical history, reason for referral, and any other relevant information must be reported on wwwlpsorgappsformshearing referral letter health.

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