Get the free Cochlear Implant (CI) Referral FormDivision of Audiology

Name: Fillable Online Cochlear Implant (CI) Referral FormDivision of Audiology Fax Email Print - pdfFiller
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Send completed forms to: Fax: 16044852759, or info@auditoryoutreach.caEquipment Request Cochlear Implant Student page 1 of 2 Student NAME:___ Birthdate: ___ (day/month/year)COMPLETED Request for Equipment

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What is cochlear implant ci referral?

A cochlear implant CI referral is a formal request for a patient to be evaluated for the potential benefits of a cochlear implant, typically made by a healthcare professional.

Who is required to file cochlear implant ci referral?

The healthcare professional or audiologist conducting the assessment and recommending the cochlear implant is required to file the CI referral.

How to fill out cochlear implant ci referral?

To fill out a cochlear implant CI referral, the healthcare professional must include patient information, medical history, hearing test results, and any other relevant clinical data.

What is the purpose of cochlear implant ci referral?

The purpose of a cochlear implant CI referral is to initiate the evaluation process for patients who may benefit from cochlear implants due to significant hearing loss.

What information must be reported on cochlear implant ci referral?

The CI referral must report patient demographics, audiological assessments, medical history, hearing aid usage, and the reasons for referral to the cochlear implant team.

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