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602-547-1111
Hearing Screening
See Also: ASDB Eligibility
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Sharing Information with Arizona Department of Health Services – Office of Newborn Screening
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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.
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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.
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Purpose:
To ensure infants and toddlers and their families receive the necessary resources and supports.
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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.
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Who shares information:
o AzEIP Service Coordinator
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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.
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Where to send information to ADHS:
o Email to: hearing@azdhs.gov
o Fax to: (602) 364-1495
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Form: Consent to Share Early Intervention Referral and Initial IFSP Date
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Resources:
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