Birth Facilities

What information should be sent to the PA Department of Health and when does it need to be sent?

Hospitals, birth centers and midwives are to notify the PA Department of Health of the hearing screening results of every newborn.


The Newborn Hearing Screening Program – Screening Reporting Form  should be completed for every newborn who receives a hearing screening and faxed to the PA Department of Health per the instructions on the form. This form may be reproduced as needed.

The Birth Hospital Monthly Reporting Form  should be completed monthly for all patients who received a hearing screening in the well-baby nursery and the NICU. This form should be faxed to the PA Department of Health per the instructions on the form.

The Out-of-Hospital Hearing Screening Reporting Form should be completed monthly for all patients who received a hearing screening. This form should be faxed to the PA Department of Health per the instructions on the form.

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The Newborn Hearing Screening and Intervention Program of the PA Department of Health (PA DOH) works with birth facilities to ensure that all newborns receive a hearing screening no later than 1 month of age. Birth facilities report newborns who did not pass their hearing screening or did not receive a newborn hearing screening to PA DOH for follow-up. Birth facilities also report newborn hearing screening results to the baby’s primary care physician for follow-up.

Find out more about the Newborn Hearing Screening and Intervention Program

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