American Speech-Language-Hearing Association

Arizona Hearing Screening Requirements for Newborns and School-Aged Children

The following information summarizes hearing screening programs for newborns and school-aged children.

The information has been collected by researching individual state statutes, regulations, policy documents, and by contacting each state. The information is reviewed on an annual basis. Please be advised that regulations and policy may change at any time, so always check with your state for the most up-to-date information.

Newborn Screening

Screening

When a birth is reported, the attending physician or person who is required to make a report on the birth shall order or cause to be ordered tests for certain congenital disorders. The results of tests for these disorders must be reported to the Department of Health Services.

Intervention

If tests indicate that a newborn or infant may have a hearing loss or a congenital disorder, the screening program shall provide follow-up services to encourage the child's family to access evaluation services, specialty care and early intervention services.

Standards/Protocols

Standards/protocols are not addressed in Arizona statutes/regulations.

Tracking/Reporting

When an initial hearing test is performed on a newborn, a health care facility's designee, a health care provider, or the health care provider's designee must provide to following information to the Department of Health Services:

  • The newborn's name, date of birth, gender, and medical record number;
  • Whether the newborn is from a single or multiple birth;
  • If the newborn is from a multiple birth, the birth order of the newborn;
  • The newborn's mother's first and last names;
  • The name and identification code of the health care facility or health care provider submitting the hearing test results;
  • The name and identification code of the health care facility of birth;
  • The name of the health care provider responsible for the coordination of medical services for the newborn;
  • The date of the hearing test;
  • Whether or not the hearing test was performed when the newborn was an inpatient;
  • The audiological equipment used for the hearing test and the type of hearing test performed;
  • The hearing test result for each of the newborn's ears; and
  • The name, address, and phone number of the contact person for the health care facility or health care provider.

If the reported results of an initial or subsequent hearing test on a newborn include an abnormal result, a health care facility's designee, a health care provider, or the health care provider's designee shall provide the following information to the Department of Health Services:

  • The newborn's race, ethnicity, and if applicable, AHCCCS identification number;
  • The mother's date of birth, name before first marriage, mailing address, and phone number;
  • If the newborn's mother does not have physical custody of the newborn, the first and last names, mailing address, and phone number of the person who has physical custody of the newborn;
  • The name of the health care provider who will be responsible for the coordination of medical services for the newborn after the newborn is discharged from the health care facility; and
  • The name and phone number of the person to whom the newborn's mother or other person who has physical custody of the newborn was referred for a subsequent hearing test.

Hearing test results must be reported each week by the sixth day of the subsequent week.

School-Age Screening

Ages/Populations Screened

  1. A student enrolled in preschool, kindergarten, or grade 1, 2, 6, or 9;
  2. A student enrolled in grade 3, 4, or 5, unless there is written documentation that the student had a hearing screening in or after grade 2;
  3. A student enrolled in grade 7 or 8, unless there is written documentation that the student had a hearing screening in or after grade 6;
  4. A student enrolled in grade 10, 11, or 12 unless there is written documentation that the student had a hearing screening in or after grade 9;
  5. A student receiving special education; and
  6. A student who failed a second hearing screening in the prior school year.

Who Can Screen

  • An audiologist;
  • An individual who is not an audiologist may perform a hearing screening only if the individual passes a hearing screener course;
  • An individual who does not meet the screener qualifications may perform a four-frequency, pure tone hearing screening, other than a second hearing screening, only under the supervision of an individual who meets the screener qualifications.

Training for Screeners

Hearing screening training course includes:

  1. Ninety minutes of classroom instruction in the introduction to hearing
  2. One hundred twenty minutes of classroom instruction in hearing screening covering:
    • Auditory development, 
    • Early identification of hearing loss, 
    • Principles of hearing screening, 
    • Selection of hearing screening methods, and 
    • Components of setting-up a hearing screening program;
  3. Seventy five minutes of classroom instruction in referral and reporting
  4. For an individual who will perform a hearing screening using three-frequency or four-frequency, pure tone hearing screening: 120 minutes of classroom instruction
  5. For an individual who will perform a hearing screening using tympanometry with three-frequency, pure tone hearing screening: 60 minutes of classroom instruction covering:
    • The anatomy and functions of the middle ear, 
    • What tympanometry measures and identifies, 
    • Using a tympanometer, 
    • Performing a tympanometry hearing screening, and 
    • Identifying children who need referral and evaluation;
  6. For an individual who will perform a hearing screening using otoacoustic emissions hearing screening: 60 minutes of classroom instruction covering:
    • What otoacoustic emissions identify and measure,
    • Using otoacoustic emissions equipment, 
    • Performing an otoacoustic emissions hearing screening, and 
    • Identifying children who need referral and evaluation;

The screener must pass the course scoring 80% or more on an examination that tests what the individual has learned. Every five years after completing a hearing screener course, a screener who is not an audiologist shall pass another hearing screener course.

Type of Testing

A screener shall perform a hearing screening in each ear using one of the following hearing screening methods:

  1. Four-frequency, pure tone hearing screening that screens at each of the following frequencies and intensities:
    • 500 Hz at 25 dB HL, 
    • 1000 Hz at 20 dB HL, 
    • 2000 Hz at 20 dB HL, and 
    • 4000 Hz at 20 dB HL;
  2. Three-frequency, pure tone hearing screening with tympanometry that:
    • Includes a tympanogram that is generated automatically or is plotted at a minimum of the following three points: 
    • +100 mm H2O, 
    • Point of maximum immittance, and 
    • -200 mm H2O; and
  3. Screens at each of the following frequencies at 20 dB HL:
    • 1000 Hz, 
    • 2000 Hz, and 
    • 4000 Hz; or
  4. Otoacoustic emissions hearing screening using otoacoustic emissions equipment that generates a pass or no pass result:
    • Using a minimum of three frequencies, 
    • At no less than 3 dB above the noise floor, and 
    • With reproducibility greater than 50%.

Equipment Standards

A school administrator shall ensure that equipment used to perform hearing screening shall be calibrated annually and inspected within 24 hours of use.

Follow-up Protocols & Documentation

If a student does not pass a second hearing screening or does not complete a second hearing screening within the time period required, a school administrator shall provide to the student's parent, within 10 days from the date of the second hearing screening or from the date the period for completing a second hearing screening ends, a referral to have the student's current hearing status evaluated by one of the following:

  • An audiologist, a physician, or a primary care practitioner if the screener used only the four-frequency, pure tone hearing screening method;
  • A physician or primary care practitioner if the student did not pass the tympanometry portion, but passed the three-frequency, pure tone portion of the hearing screening;
  • An audiologist if the student did not pass the three-frequency, pure tone portion, but passed the tympanometry portion of the hearing screening; or
  • An audiologist, a physician, or a primary care practitioner if the screener used the otoacoustic emissions hearing screening method.
  • A school administrator shall retain, for Department of Health Services review and inspection, a written record of:
  • The date and results of a student's hearing screening for no less than three complete school years beginning on the first July 1 after the student's last date of attendance at the school, and
  • All calibration dates for a piece of hearing screening equipment currently used in the school.
  • By June 30 of each year, a school administrator shall submit to the Department of Health Services the following information for the school year ending that June 30.
  • The number of students by grade in each of the following categories: 
    • Were enrolled at the time of a first hearing screening,
    • Did not have a first hearing screening, 
    • Had a first hearing screening, 
    • Did not pass a first hearing screening, 
    • Had a second hearing screening, 
    • Did not pass a second hearing screening, 
    • Were evaluated by an audiologist, 
    • Were evaluated by a physician or a primary care practitioner, 
    • Were first diagnosed as deaf or hard of hearing during the current school year, and 
    • Were diagnosed as deaf or hard of hearing during a prior school year; and 
    • The name of each individual who performed a hearing screening in the school and: 
    • The individual's license number to practice audiology, or 
    • Evidence that the individual successfully completed a hearing screening course.

Resources

For further information on hearing screening requirements, visit these websites:

Questions regarding state advocacy issues? Call ASHA at 800-498-2071 and ask for the State Advocacy Team.

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