Get Ca Nhsp 100-1 Region D 2010-2025

Filling out the CA NHSP 100-1 Region D form is an essential task for ensuring accurate newborn hearing screening reporting. This guide provides a detailed walkthrough to help you complete the form effectively and efficiently.

Follow the steps to complete the CA NHSP 100-1 Region D form online.

1. Click ‘Get Form’ button to access the CA NHSP 100-1 Region D form and open it in your preferred online editor.
2. Begin with the section labeled 'Inpatient (IP) Screen Completed'. Here, indicate the results for both the right and left ears by selecting either 'Pass' or 'Refer' for each type of screening: ABR, DPOAE, and TEOAE.
3. In the 'Type of Screening' section, check the appropriate box to specify the type of screening conducted: ABR, DPOAE, or TEOAE.
4. If the inpatient screen was not completed, provide details in the designated section, selecting the reason for not screening such as 'Transferred out,' 'Missed,' or 'Waived,' and include any necessary follow-up information.
5. Complete the 'Follow-Up for Referrals/Missed' section. Verify and update information for the Parent/Legal Guardian, including primary language and secondary contact details.
6. Print the infant’s full/legal name and check whether the NHSP brochure was given to the parent regarding referral or follow-up appointments.
7. Fill in the follow-up appointment date and time if applicable, and document any referrals made to CA Children’s Services or other specified providers.
8. After reviewing all the entered information, ensure accuracy, and make any necessary edits. Save your changes, and you may choose to download, print, or share the completed form as required.

Complete your CA NHSP 100-1 Region D form online to ensure timely and accurate submission.