Get Utah Newborn Hearing Screening & Cchd Weekly Reporting Form

Navigating the Utah Newborn Hearing Screening & CCHD Weekly Reporting Form is essential for ensuring the health and well-being of newborns. This guide will provide step-by-step instructions for filling out the form accurately and efficiently online.

Follow the steps to complete the reporting form effectively.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering the baby information, including the baby’s name, date of birth, gender, and blood spot kit number. Make sure all information is recorded clearly.
3. Next, fill out the mother’s information, which includes her name, date of birth, phone number, and address. Please ensure the details are up to date.
4. For the initial and rescreening dates, provide the testing dates for both the right and left ears, marking whether the result is 'Pass' or 'Refer' accordingly.
5. Complete the section for the baby's pediatrician or medical doctor, including their name and facility.
6. Proceed to the CCHD screening results section. Record the results for the baby's right hand and either foot at the designated intervals. Again, mark whether the results are 'Pass,' 'Fail,' or 'Rescreen'.
7. If a CMV test was ordered, indicate 'Yes' or 'No' in the appropriate field. If screening was not conducted, provide a reason in the space provided.
8. Finally, review all filled details, ensuring accuracy and completeness. Once verified, save your changes, and choose your preferred method to download, print, or share the completed form.

Complete the form online to ensure timely submission and accurate reporting.