Get Hearing Screening Form

Filling out the Hearing Screening Form online is a straightforward process that ensures accurate documentation of a child's hearing health. This guide will provide you with step-by-step instructions to complete the form efficiently.

Follow the steps to properly complete the Hearing Screening Form online.

1. Click ‘Get Form’ button to access the Hearing Screening Form and open it in your preferred editor.
2. In the first section, enter the child’s name and date of birth in the designated fields. Ensure that you provide the correct spelling and format for these details.
3. Next, input the center name and class code as required. This information helps identify the specific location and class of the child being screened.
4. Fill in the tester's name along with the test date. This ensures accountability and accurate tracking of who conducted the hearing test.
5. Now, detail the hearing screening results for both the right and left ears at the specified frequencies of 1000, 2000, and 4000 Hz. Mark either 'Pass' or 'Refer' next to each frequency based on the test outcomes.
6. If a recheck is necessary, provide the date of the hearing recheck and the tester's name in the respective fields. Similar to the initial screening, enter the results for each ear at the specified frequencies.
7. Finally, please staple any additional AuDx testing results to the designated area of the form, ensuring all relevant documentation is attached.
8. After completing all fields, you can choose to save the changes made to the document, download it for your records, print a hard copy, or share it as needed.

Complete the Hearing Screening Form online to ensure proper documentation of your child's hearing health.