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).