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Click ‘Get Form’ to open it in the editor.
Begin by entering the newborn's information, including their name, date of birth, hospital of birth, and medical ID number. Ensure accuracy as this data is crucial for tracking.
Fill in the parent/guardian contact information. Include the mother’s name, phone number, and address to facilitate communication regarding the screening results.
Indicate the primary care physician's details. This section helps in coordinating follow-up care if necessary.
Complete the hearing screening results section by marking whether each ear passed or referred. Specify the method used for screening (AABR or OAE) based on initial tests.
In the comments section, note any risk indicators for delayed-onset hearing loss and ensure that all relevant information is included for audiology evaluation.
Finally, review all entries for completeness before submitting. Use our platform’s features to save your progress and share it directly with relevant parties.
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