Action kit for audiologists

Improving follow-up after newborn hearing screening An action kit for audiologists

Tools Glossary

Improvement area: Pre-appointment activities

Tool	Description
Pre-Appointment Checklist	The pre-appointment checklist can be used by providers and staff to ensure they are prepared to care for infants who do not pass their final hearing screen and are preparing to be seen by audiology
Pre-Appointment Data Collection Tool	This tool can be used to collect, report and analyze data collected by the pre-appointment checklist
Missouri Daily Log Template	This template can be utilized to verify that a faimily has received writtedn pre-appointment instructions in the mail prior to the first appointment
Idaho Your Baby's Hearing Test	A one page handout to help families prepare for a diagnostic appointment
MN - Preparing for Your Baby's Audiology Visit	A one page handout to help families prepare for a diagnostic appointment
ND Survey for Reminder Calls	A short survey used to collect feedback on the completion of reminder calls and the impact on show rates
WA PCP Referral Fax	Fax form to improve communication from Audiologist to PCP

Improvement area: Appointment

Tool	Description
Idaho Your Baby's Hearing Test	A one page handout to help families prepare for a diagnostic appointment
The "What Else" Checklist	Created by the CDC to support audiologist in appointments with families
Scripts for Primary Care Providers	Scripts for Primary Care Providers to utilize when communicating newborn hearing screeing results to parents/families
Teachback Training	Information on utilizing teachback with parents/families
WI Babies and Hearing Loss - English	A guide for families about follow-up medical care for infants with hearing loss
WI Babies and Hearing Loss - Spanish	A guide for families about follow-up medical care for infants with hearing loss in spanish
NJ Next Steps Checklist	A checklist for families to understand the next steps following the diagnostic appointment
AK Newborn Screening Packet	Packet of information used to track children who do not pass
TN Next Steps Document	A tool for audiologists to plan next steps for infants with hearing loss

Improvement area: Reporting results

Tool	Description
NJ Next Steps Checklist	A checklist for families to understand the next steps following the diagnostic appointment
Referral Fax Back Audiologist to PCP	A fax back form that improves communication between an audiologists and primary care providers
ID Reminder Sticker	A small sticker to remind providers to document needed next steps
NM Report of Audiological Results	One page report to document specific outcomes of the audiological exam
NE Diagnostic Report Form	One page report to document specific outcomes of the audiological exam
LA EHDI Fax to Audiologists	a fax back form to improve communication between EHDI and Audiologists
TX Quick Reference Guide	Quick reference guide for Audiologists

Improvement area: Next steps following diagnosis

Tool	Description
NJ Next Steps Checklist	A checklist for families to understand the next steps following the diagnostic appointment
AK Newborn Screening Packet	Packet of information used to track children who do not pass
TN Next Steps Document	A tool for audiologists to plan next steps for infants with hearing loss
ID Reminder Sticker	A small sticker to remind providers to document needed next steps
Diagnostic Appointment Checklist	A checklist to ensure all necessary steps occur duing a diagnostic appointment with a child
Audiology Checklist Data Collection Tool	A tool to collect data on the completion of the diagnostic appointment checklist
ND Fax form for EI Referral	A form to fax a referral to Early Intervention
CDC Brochure - Questions you may want to ask your EI Provider	A brochure for families to think of questions they may like to ask their EI provider
"Just in Time" Hearing-Related Resources	A resource to use with families to support them to get the information they need for their newly diagnosed child