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How to fill out the IL DPH HC-18 online
The IL DPH HC-18 form is essential for collecting hearing screening data in Illinois. This guide will provide you with comprehensive instructions on how to complete each section of the form online, ensuring accurate submission and compliance with reporting requirements.
Follow the steps to complete the IL DPH HC-18 form online.
- Click the ‘Get Form’ button to obtain the form and access it for editing.
- In the screening section, enter all total screening data for preschool children in line a and for school-age children in lines b through o. Make sure to include all full-time special education class children on line o. For each column, complete the following: 1. Number screened: total number of children screened. 2. Number rescreened: total number of children who underwent rescreening. 3. Number of thresholds: total children receiving threshold tests following a second screening test failure, including those with inconclusive results. 4. Thresholds known cases and monitoring: total thresholds for known cases like those on watch lists or with hearing aids. 5. Number referred: total children meeting medical referral criteria or showing symptoms of ear pathology.
- Proceed to the follow-up results section. Enter all follow-up results for school-age children in column 6 and preschool children in column 7. Additionally, input the sums for lines q (completed referrals) and r (referrals not completed) in column 8. Ensure that the totals for columns 6, 7, and 8 are correctly calculated and entered on line s. These entries must equal the total number of children referred, recorded in cell 5-p.
- In the diagnosis section, enter all diagnostic data for school-age children in column 6 and preschool children in column 7. Calculate and enter the sums of lines t through z in column 8, and verify that these sums correspond with the total number of completed medical referrals noted in cell 8-q. Enter the counts detailing conductive losses, non-organic losses, sensorineural losses, mixed losses, and normal findings.
- Fill out the program information by typing or printing the agency's name (like school district or health department), address, contact person's name, phone number, and the submission date. Ensure clarity and legibility.
- Finally, review all entries for accuracy, save your changes, and prepare to submit the completed form by the June 30 deadline. You can download, print, or share the document as needed.
Complete your IL DPH HC-18 form online today to ensure your submission is accurate and timely.
Yes, you can obtain a medical card at 18 in Illinois if you meet the state's criteria. The IL DPH HC-18 outlines specific conditions and qualifications. You must have a qualifying medical condition and a recommendation from a licensed physician. Navigating the application process can be simpler when using uslegalforms for guidance.
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