Hearing Diagnostic Report 2026

1. Click ‘Get Form’ to open the Hearing Diagnostic Report in the editor.
2. Begin by filling in the demographic data. Enter the child’s name, birth name, date of birth, and mother’s name. Ensure you provide accurate contact information including email and phone numbers.
3. Next, indicate the results of the Newborn Hearing Screening by checking the appropriate box: Pass, Refer, or Not Screened. Record the birth hospital's name.
4. In the Risk Factors section, check all applicable boxes that relate to potential hearing loss risks for your child.
5. For Evaluation Procedures, enter the appointment date and check whether it was an initial or follow-up appointment. Indicate if any evaluations were unable to be completed.
6. Document confirmed hearing status for both ears by checking the relevant boxes for normal hearing or degree/type of hearing loss.
7. Finally, complete any referrals needed and add comments regarding ear malformations or other relevant factors before submitting your report.

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