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Hearing and vision screening forms 2026

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The document outlines the results of hearing and vision screenings for students, detailing the instruments used, screening outcomes, and specific behavioral observations to assess children's responses to auditory and visual stimuli. It includes sections for recording pass/fail results and additional qualitative descriptions for severely handicapped children who may not respond to standard screenings.

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Click ‘Get Form’ to open the hearing and vision screening form in the editor.
Begin by entering the student’s name, school, age, and district at the top of the form. This information is essential for identifying the individual being screened.
In Part I, complete the Hearing Screening section by selecting the instrument used and marking whether it was a first or second screening. Indicate if glasses were worn during the vision screening.
For each eye in the Vision Screening section, record results for far vision (right eye, left eye, both eyes) and near vision. Mark PASS or FAIL as appropriate.
In Part II, assess responses to various auditory and visual stimuli. Answer each question based on observations made during screenings. Provide detailed notes where necessary.
Finally, ensure that all examiners sign and date their respective sections to validate the assessments conducted.

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What is hearing and vision screening?

The Vision, Hearing, Spinal Screening Program is a program of early detection to identify children ages 4-18 years of age, with vision and hearing disorders and adolescents with abnormal spinal curvatures and refer them for appropriate follow-up with their doctor.

Why is vision and hearing screening important in schools?

Periodic vision and hearing screening is recognized as an integral part of preventive paediatric health care (1). Adverse effects on educational and social development are obvious consequences of poor visual and hearing acuity.

What is a vision and hearing screening?

To obtain your vision and hearing screening certification, you must attend and pass the Department of State Health Services certification training. The certification is valid for five years. The requirement for renewing the certification is to attend and pass another certification (re-certification) training.

What does a hearing screening consist of?

The evaluation is comprised of medical history, physical exam of the ears and a series of hearing tests such as a middle ear or tympanometry test, speech testing, pure-tone test, auditory brainstem response and otoacoustic emissions.

How to get certified for vision and hearing screening in Texas?

Get specialized care for your eyes and ears. Vision services include eye exams, contact lens fittings, and prescription eyeglasses. Hearing services include hearing tests, explanation of test results, and product demos.