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Ohio Department of HealthHearing Referral Letter
Date ___
Dear Parent:
Your children result on the hearing screening test given in ___
school seems to indicate that an ear, nose, throat and hearing
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How to fill out hearing screening forms
How to fill out hearing screening forms
01
Gather the necessary information such as personal details and medical history of the individual being screened.
02
Ensure you have the appropriate hearing screening form that matches the specific requirements of the screening process.
03
Fill out the form accurately and legibly, providing all required information.
04
Verify the information provided and make sure it is complete before submitting the form.
05
Follow any additional instructions or guidelines provided by the healthcare professional conducting the screening.
Who needs hearing screening forms?
01
Individuals who are required to undergo a hearing screening as part of a routine check-up.
02
Children who may be experiencing hearing difficulties or delays in speech development.
03
Adults who have been exposed to loud noises or have a history of hearing problems.
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What is hearing screening forms?
Hearing screening forms are documents used to assess an individual's ability to hear and detect any potential hearing loss.
Who is required to file hearing screening forms?
Typically, schools, healthcare facilities, and employers are required to file hearing screening forms for individuals under their care or employment.
How to fill out hearing screening forms?
Hearing screening forms can be filled out by providing information about the individual being screened, the type of screening performed, and the results of the screening.
What is the purpose of hearing screening forms?
The purpose of hearing screening forms is to identify any potential hearing loss in individuals and to provide appropriate intervention or treatment.
What information must be reported on hearing screening forms?
The information reported on hearing screening forms typically includes the individual's name, date of birth, screening date, screening results, and any follow-up recommendations.
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