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  • Mi Hearing Screening Form 2021

Get Mi Hearing Screening Form 2021-2025

Hospital of Birth: Date of Birth: Kit # Male Female Twin: A B C Initial Screen Date: Method: A-ABR ABR OAE Results: Right Ear: Pass Refer Left Ear: Pass Refer Medical Record #: - Parent/Guardian Contact Information Mother s Name:.

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Document each frequency screened in a manner that indicates the decibel it was screened at and whether the result was a PASS or REFER. Use consistent notations with a key indicating which symbols or words denote PASS and REFER so that results are clear to caregivers/guardians and providers.

Recommended Early Hearing Detection and Intervention (EHDI) benchmarks include screening for hearing loss before 1 month of age, diagnostic evaluation before 3 months of age, and enrollment in early intervention before 6 months of age, known as the 1-3-6 benchmarks.

Document each frequency screened in a manner that indicates the decibel it was screened at and whether the result was a PASS or REFER. Use consistent notations with a key indicating which symbols or words denote PASS and REFER so that results are clear to caregivers/guardians and providers.

Within normal limits (-10 to 20dB): hearing is normal for an average human adult. Mild (20-40dB): there is a small degree of hearing loss, so quiet sounds like whispering and leaves rustling may not be heard.

A hearing screening is a quick test that you will pass or fail. If you pass, then you show no signs of hearing loss. If you fail, you will need more in-depth hearing testing. You should see someone trained to do hearing screenings, like an audiologist, nurse, or teacher.

Children get screenings at school or at the doctor's office. Adults can go to the doctor or local health fairs for a screening. You should ask your doctor for a hearing screening if you have concerns about your or your child's hearing. An audiologist can give you a more complete hearing test if you fail the screening.

“Audiologic function testing (CPT® codes 92550-92588) includes testing of both ears, and only one unit of service for any of these CPT® codes may be reported for the described testing on both ears. If only one ear is tested, the appropriate CPT® code should be reported with modifier 52 [Reduced services].”

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232