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How to use or fill out NHSP 100-1 Region D with our platform
- 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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