Get Attention Parents. Did Not Pass Sheet For Newborn Hearing Screening - Health State Mn

Completing the Attention Parents. Did Not Pass Sheet For Newborn Hearing Screening is essential for ensuring follow-up care for your baby. This guide provides clear and supportive instructions to help you fill out the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the Attention Parents. Did Not Pass Sheet For Newborn Hearing Screening form and open it in your preferred document editor.
2. Fill in the name of your baby's primary care provider in the designated space labeled ‘ATTN: Primary Care Provider:’.
3. Indicate the name of the clinic where the primary care provider practices in the section labeled ‘Clinic:’.
4. Enter your baby’s name in the field marked ‘Baby’s Name.’
5. Insert your baby’s date of birth in the field labeled ‘Baby’s Date of Birth.’
6. Document the hospital or birth site where your baby was born in the section marked ‘Hospital/Birth Site.’
7. Provide the date of the last hearing screen in the field labeled ‘Date of Last Hearing Screen.’
8. For the right ear, select either ‘Pass’ or ‘Refer’ to indicate your baby's hearing screening results.
9. For the left ear, similarly select either ‘Pass’ or ‘Refer.’
10. If an appointment for hearing testing/rescreen has been made, fill in the date and location in the section provided.
11. Once all fields are filled out accurately, you can save the completed document, download it for your records, print it for in-person visits, or share it with your primary care provider as needed.

Complete your documents online today for your baby's health needs.