Guidelines and Forms

 

 

Guideline for Reporting Hearing Screening Results to DHSS

All results of hearing screenings shall be reported to the DHSS Newborn Hearing Screening Program.

Who Should Report Infant Hearing Screenings?

  • Hospitals
  • Audiology facilities
  • Primary care physician offices
  • Home birth centers

What Screening Results Should Be Reported?

  • Initial hearing screening results for newborns who pass or refer on an initial hearing screening
  • Repeat hearing screening results for newborns who pass or refer on a repeat hearing screening
  • Missed screenings of newborns due to: transfer to another facility, transfer to NICU, equipment failure, or infant’s death

How Are Initial Hearing Screening Results Reported?

  • Direct entry of initial hearing screening results by birth hospitals through the Missouri Electronic Vital Records (MoEVR). The MoEVR Hearing Screening User Access and Instruction Manual is located here.
  • Completion of the Initial Hearing Screening Form (hearing section of blood spot screening packet)
  • Completion of the Hearing Screening Only Result Form when the hearing screening performed by a hospital has not been reported in MoEVR or on the Initial Hearing Screening Form

How Are Repeat Hearing Screening Results Reported?

  • Entered as repeat screening in MoEVR
  • Completion of the Hearing Screening Only Result form if unable to access MoEVR

How to Obtain Hearing Screening Only Result Forms

  • Order Hearing Screening Only Result Forms (BGDP-3) at no cost from the DHSS warehouse (http://health.mo.gov/warehouse).
  • Access Hearing Screening Only Result Form online here. Complete the form online, then print the form.

How to Submit Hearing Screening Only Result Forms

  • Fax completed forms to: 573-751-6185, or
  • Mail to:
    Missouri Department of Health and Senior Services
    Newborn Hearing Screening Program
    Bureau of Genetics and Healthy Childhood
    P.O. Box 570
    Jefferson City, MO 65102-0570

When to Report Screening Results

Missouri Regulations 19CSR 40-9.010-40-9.040 require that hearing screening results be submitted within seven (7) days of completion of the hearing screening.

 

Guideline for Reporting Audiologic Diagnostic Results to DHSS

Audiologic Diagnostic Results Are Reported For:

  • Newborns who refer on the initial or repeat screening, receive a diagnostic Auditory Brainstem Response (ABR) and are diagnosed with normal hearing bilaterally;
  • Newborns who refer on the initial or repeat screening, receive a diagnostic ABR and are diagnosed with hearing loss (any type, degree or laterality); and
  • Newborns who pass the initial or repeat screening, 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.

 

How to Report Diagnostic Results to DHSS

Audiologic reports can be submitted by:

  • Direct entry into the DHSS data base. Please request direct-entry access by contacting the Newborn Hearing Screening Program at: 1-800-877-6246, or
  • Completion of the Audiologic Diagnostic Form that is available here. Complete the form online, then print the form and fax or mail to:
    Fax: 573-751-6185 or
    Missouri Department of Health and Senior Services
    Newborn Hearing Screening Program
    Bureau of Genetics and Healthy Childhood
    P.O. Box 570
    Jefferson City, MO 65102-0570

When to Report

Missouri Regulations 19CSR 40-9.010-40-9.040 require that audiologic diagnostic reports be submitted within 7 days of completion of the audiologic diagnostic evaluation.

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.

Other Information 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.