Hearing Screening

See Also:  ASDB Eligibility

Sharing Information with Arizona Department of Health Services – Office of Newborn Screening

 

Arizona Department of Economic Security (ADES) and the Arizona Department of Health Services (ADHS) has an Intergovernmental Agreement (IGA) to insure interagency cooperation with the implementation and maintenance of a statewide comprehensive, coordinated, multidisciplinary and interagency system of early intervention services for eligible infants and toddlers, ages birth to three years, and their families.

 

Arizona Revised Statute 36-694 mandates the reporting of all hearing screenings for both newborns and infants (up to two years of age) to the Office of Newborn Screening. As prescribed by A.A.C. R9-13-207(E), all screening and diagnostic hearing evaluations shall be submitted within one week following the hearing screen or evaluation, even if the results are normal.

 

Purpose:

To ensure infants and toddlers and their families receive the necessary resources and supports.

 

When to share information with ADHS:

o When AzEIP SC completes OAE screening for all children up to age 2.

o Newborn and infants (up to age three) who are deaf or hard of hearing and are referred to AzEIP.

o Reporting required within 7 days of hearing screening.

 

Who shares information:

o AzEIP Service Coordinator

 

What to share:

o AzEIP Consent to Share Early Intervention Referral and Initial IFSP Date (GCI-1109A FORFF) (06-18))

* Form is on the AzEIP website.

* Completed for all children with confirmed hearing loss.

* Completed with the family.

* Copy uploaded to Central Reach.

o AzEIP Hearing Screening Tracking Form

* Form is on the AzEIP website.

* Copy uploaded to Central Reach.

 

Where to send information to ADHS:

o Email to: hearing@azdhs.gov

o Fax to: (602) 364-1495

Form:  Consent to Share Early Intervention Referral and Initial IFSP Date

Resources:  

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