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Hearing Screening Documentation, Tracking and Monitoring Tools

a smiling boy during a hearing screening test

Early childhood program coordinators and staff often need help in documenting hearing screening outcomes, tracking children who need follow-up, and monitoring screening program quality.

Step 1: Documenting Hearing Screening and Diagnostic Outcomes

These forms make it easy to record ear-specific outcomes for each child’s health record while guiding screeners through the protocol and "next steps" needed:

OAE Screening Form [PDF] or Pure Tone Screening Form [PDF]. Print one copy of the form for every child who will be screened and record outcomes as screening is conducted. (Alternately, you can access and use the fillable version of the OAE Screening Form [PDF] directly on your computer.) The completed form can be filed as part of the child’s health record and can also be transmitted to the health care provider or audiologist if a particular child requires follow-up evaluation after screening.

Diagnostic Follow-up Form [PDF] or Diagnostic Follow-up Form (Pure Tone Version) [PDF]. Print one copy of the form for every child who needs follow-up after OAE or Pure Tone screening [typically less than 10% of the total screened]. As prompted by the protocol, obtain diagnostic outcome information from the health care provider and/or pediatric audiologist.

Step 2: Tracking Hearing Screening and Follow-up Diagnostic Activities (Revised)

Download the simple-to-use Excel® spreadsheet which has been designed to help you track which children have completed the screening process and which need follow-up. The spreadsheet also calculates important quality indicators for your hearing screening program

ECHO Hearing Screening & Diagnostic Log (2016) [XLSX] (Excel® spreadsheet formatted to reflect the hearing screening and follow-up protocol—all you do is enter child information and results.)

Instructions for using the Hearing Screening & Diagnostic Log: