Guide: See "Your Baby's hearing and speech" - pg20-21.

Choose a Result Satisfactory (S) Observation (O) In Treatment (T) Referral (R) Not Examined (N)

Choose a Referral Code 1. Area Medical Officer 2. Audiologist 3. Clinical Psychologist 4. Child + Family Centre 5. Child Psychiatrist 6. Counselling Nurse for Persons with Special Needs 7. Cnslt. ENT Surgeon 8. Cnslt. Ophthalmst. 9. Cnslt. Ortho. Surgeon. 10. Comm. Paediatrician 11. Comm. Ophthalmic Physician 12. Cnslt. Paediatrician 13. Cerebal Palsy Ireland 14. Centre for Persons w/ Learning Disability 15. Centre for Persons w/ Physical Disability 16. Dentist 17. Early Intervention Team. 18. Ed. Psychologist 19. Environmental Health Officer 20. GP 21. Home Help Organiser 22. Nutritionist + Dietitian 23. OT 24. Physio 25. Speech + LT 26. Social Worker 27. CWO 28. Other 29. Second Tier Service

Parental Concern Yes No







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