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NHSP 100-1 Region D. NHSP 100-1 Region D

NHSP 100-1 Region D. NHSP 100-1 Region D 2025

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4.7 out of 5

58 votes

The document is an Infant Reporting Form for Newborn Hearing Screening, detailing the procedures and results of hearing tests conducted on newborns in a hospital setting. It includes sections for recording screening results (ABR, DPOAE, TEOAE), follow-up actions for referrals or missed screenings, and parent/legal guardian information. The form also outlines various scenarios such as transfers, waivers, and medical exemptions from screening.

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Click ‘Get Form’ to open the NHSP 100-1 Region D in our editor.
Begin by entering the hospital name at the top of the form. This identifies where the screening took place.
Fill in the 'Date of Screening' and check the appropriate boxes for 'ABR', 'DPOAE', or 'TEOAE' based on the type of screening conducted for both ears.
Indicate the results for each ear by checking either 'PASS' or 'REFER'. Ensure that you complete this for both right and left ears.
If applicable, complete the section regarding inpatient screening not done, providing details such as transfer information or reasons for missed screenings.
In the follow-up section, verify and update parent/legal guardian information, including primary language and contact details.
Finally, ensure all required signatures are obtained before submitting your completed form through our platform.

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2016	4.5 Satisfied (24 Votes)
2010	4.7 Satisfied (58 Votes)

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