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Forms and Instructions

Special Child Health Services Registration Form
SCH-0 - This form is for reporting children with diagnosed hearing losses to the Special Child Health Services Registry and will facilitate linkage with Case Management and Early Intervention Services.

Follow-up Report Form and Instructions
SCH-2 - This form is for reporting outpatient hearing screening/testing results to the New Jersey EHDI program.

Lost to Hearing Follow-up Report and Instructions
SCH-3 - This form is for notifying the New Jersey EHDI program of children that are not expected to have follow-up testing reported.

Module 6 Worksheet
REG-4 - This “Parent/Guardian Consent and History” worksheet is completed by the hospitals and submitted to the Department via the Electronic Birth Certificate system (EBC).

Department of Health

P. O. Box 360, Trenton, NJ 08625-0360
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Last Modified: Monday, 28-Jul-14 09:21:43