- Audiologic Diagnostic Form
- Guidelines for Hospital-Based Newborn Hearing Screening Programs
- Hearing Screening Only Result Form
Guideline for Reporting Audiologic Diagnostic Information to DHSS
How to Report
Reports may be completed on a paper reporting form that is then mailed to the Missouri Department of Health and Senior Services (DHSS). The audiologic reporting form is available through the Bureau of Genetics and Healthy Childhood and can be requested by calling 1-800-877-6246. The form can also be requested via email to KrisGrbac@MissouriState.edu. The form is also available online. The completed form should be mailed to:
Missouri Department of Health and Senior Services
Newborn Hearing Screening Program
Bureau of Genetics and Healthy Childhood
930 Wildwood P.O. Box 570
Jefferson City, MO 65102-0570
Who to Report
The following provides a listing of reports requested for infants born on or after January 1, 2002:
- Newborns who refer on the initial or repeat screen, receive a diagnostic Auditory Brainstem Response (ABR) and are diagnosed with normal hearing bilaterally;
- Newborns who refer on the initial or repeat screen, receive a diagnostic ABR and are diagnosed with hearing loss (any type, degree or laterality);
- Newborns who pass the initial or repeat screen, who later receive a diagnostic ABR and are diagnosed with sensorineural hearing loss or permanent conductive hearing loss.
NOTE: If a child passes the newborn hearing screening and is later diagnosed with a non-permanent conductive hearing loss due to transient middle ear pathology, it is not necessary to submit a report.
When to Report
Missouri Regulations 19CSR 40-9.010-40-9.040 require that reports be submitted within 7 days of completion.
Frequency of Reporting
Once a child is diagnosed with hearing loss, reports for all follow-up exams should be submitted. This is especially important when repeat examination is needed to confirm a diagnosis.
Once behavioral testing commences, a report that includes a pure tone audiogram should be submitted when it is available. If behavioral testing commences, but initial sessions result only in training and no pure tone thresholds are established, it is not necessary to send a report. Audiologists should use discretion about submitting behavioral reports. Reports should be submitted when they contain enough information to confirm the ABR diagnosis or change the ABR. DHSS provides no specific form for submitting behavioral test results. Audiologists should send a copy of the audiogram and report that they typically use to communicate test results.
Once a diagnosis that contains type, degree and laterality of hearing loss for 500 Hz through 8000 Hz has been established by behavioral testing, reports should be submitted annually or sooner if there is a change in hearing status. Annual reports should be submitted for the first 5 years of life.
If a child with hearing loss leaves the service of the audiologist that diagnosed the hearing loss, that audiologist should inform the DHSS that they are no longer seeing this child.
If the child was diagnosed with normal hearing bilaterally, but had a high risk factor for late onset or progressive hearing loss and will have hearing monitors, a report should be submitted at every monitor.
What to Report
In addition to ABR diagnostic information, the reporting form requests information on risk factors and recommendations. Audiologists should complete these sections as well as the test results section.