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Newborn Hearing Reporting Resources

Audiology Forms

UIC-DSCC 0345 Form: Early Hearing Detection & Intervention Program Diagnostic Evaluation Summary (pdf)

UIC-DSCC 0345 Form: Early Hearing Detection & Intervention Program Diagnostic Evaluation Summary (docx)

IDPH Hearing Screening Reporting Form (Fillable) (pdf)

IDPH Audiological Diagnostic Evaluation Reporting Form (pdf)

Reporting Form for Screeners

Local Health Department Reporting Form (pdf)

Home Visiting Hearing Screening Reporting Form (pdf)

Physician Follow-up Forms

IDPH Physician Follow-up Form (pdf)

IDPH Screening Follow-up Form (pdf)

Fact Sheets

DSCC Facts: Audiology Services (Form 17.14) (pdf)