Each hospital is required to fill out the form entitled "Newborn Hearing Screening Report" (NHSR) on each infant born or transferred into a birthing hospital.

This multiple part NHSR form should be completely filled out with identifying information and hearing screening results. Any risk factors that are present are to be documented as these risk factors are important for long-term follow-up of progressive hearing loss.

One copy is to be kept in the infant's medical record, and one copy is to be provided to the post discharge PCP. The fourth copy is to be distributed to the parents, and (only if needed) a copy is also available to be mailed to the LDH Office of Public Health. 

The information from the NHSR is sent in electronically by your Health Information Management Birth Certificate Clerk by recording the results of the NHSR form in the Hearing Screening page of the LEERS system.

The LDH hard copy of the form however must be mailed in cases of infants that are not screened due to being transferred to another facility, due to death, or due to hospital re-admission testing. This information cannot be transmitted by the current electronic birth certificate. In these cases, the complete name as found on the birth certificate and identifying information must be entered and the form mailed to:

LDH Office of Public Health
Hearing Speech and Vision Program
ATTN: Anna Wells
PO Box 60630
New Orleans, LA 70160
Fax: 504-568-5854