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Date referral received from school district: ___ Date referral emailed/mailed to educational audiologist ___REFERRAL FOR HEARING SUPPORT SERVICES Service(s) Requested: Determination of Eligibility
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How to fill out school based audiologist services

01
Gather all necessary information regarding the student's hearing history and any previous audiology assessments.
02
Schedule a meeting with the student's parents or guardians to discuss the services and obtain consent.
03
Conduct a comprehensive audiological assessment to determine the student's hearing abilities and needs.
04
Develop an individualized plan for the student based on the assessment results and any other relevant information.
05
Implement the plan by providing appropriate services and accommodations as needed.
06
Monitor the student's progress and make any necessary adjustments to the plan as needed.
07
Communicate regularly with the student's parents, teachers, and other relevant stakeholders to ensure continuity of care.

Who needs school based audiologist services?

01
Students who have been diagnosed with hearing loss or other auditory processing disorders.
02
Students who have trouble hearing in noisy environments or classroom settings.
03
Students who have difficulty understanding speech or language development.
04
Students who require assistive listening devices or other accommodations to help them access education.
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School based audiologist services provide audiology support to students within a school setting.
School administrators or designated staff members are typically responsible for filing school based audiologist services.
School based audiologist services can be filled out by providing detailed information about the audiology services provided to students within the school.
The purpose of school based audiologist services is to ensure that students with hearing impairments receive necessary support to succeed academically.
Information such as the number of students receiving audiology services, types of services provided, and outcomes of the services may need to be reported on school based audiologist services.
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