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Oregon ehdi diagnostic form edit

Oregon ehdi diagnostic form edit 2026

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The document is a Diagnostic Form for the Early Hearing Detection and Intervention (EHDI) Program, designed to collect essential information about a child referred for hearing evaluation. It includes sections for personal details, screening results, follow-up procedures, and risk factors associated with hearing loss. The form emphasizes the importance of timely contact with families and outlines steps for scheduling evaluations and reporting outcomes to the Department of Human Services.

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Click ‘Get Form’ to open the Oregon EHDI Diagnostic Form in the editor.
Begin by filling in the 'Referral Received' date and the source of referral. Ensure you complete all required fields marked with an asterisk (*).
Input the child's personal information, including their last name, first name, date of birth, and gender. Select the appropriate address type and provide contact details.
Complete the sections regarding screening at birth, audiologist's information, and evaluation status. Make sure to check off any necessary follow-up actions based on your assessment.
Document any known risk factors using the provided codes. Discuss early intervention options with the family and indicate whether resources were shared.
For follow-up logs, record attempts to contact the family, ensuring to note dates and times for each call made.
Once completed, review all entries for accuracy before submitting. Use our platform’s export feature to save or send your filled form directly.

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