[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-537738-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-537738-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","illinois-department-of-public-health-hearing-conservation-annual-report-instructions-for-completing-form-hc-18","ILLINOIS DEPARTMENT OF PUBLIC HEALTH - HEARING CONSERVATION ANNUAL REPORT - Instructions for Completing Form (HC-18)","","Instructions for completing the Illinois Department of Public Health Hearing Conservation Annual Report form (HC-18) by entering screening, rescreening, and threshold-related counts for preschool and school-age children. The form also requires follow-up outcomes for referred children, totals and cross-checks across specified lines, and diagnostic results by category including conductive, non-organic, sensorineural, mixed, and normal findings. Includes program and submission details, ensuring computations are verified and one cumulative annual summary is submitted by June 30.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/illinois-department-of-public-health-hearing-conservation-annual-report-instructions-for-completing-form-hc-18/537738/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/illinois-department-of-public-health-hearing-conservation-annual-report-instructions-for-completing-form-hc-18/537738.png","ImageObject",300,407,{"name":42,"@type":43},"PakDamar76","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-16","2026-10-10",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",7,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What screening data must be entered for preschool and school-age children?","Question",{"text":63,"@type":64},"Enter screening totals by preschool (line a) and school age (lines b–o). Full-time special education class children must be entered on line o.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How are follow-up results for referrals verified on the form?",{"text":68,"@type":64},"Follow-up outcomes are entered by school age (column 6) and preschool (column 7), then summed into column 8 and line s. The totals in column 8 and line s must match, and the cell 8-s total must equal the number of children referred (cell 5-p).",{"name":70,"@type":61,"acceptedAnswer":71},"How are diagnostic categories recorded and checked for totals?",{"text":72,"@type":64},"Diagnostic data is entered by school age (column 6) and preschool (column 7), then summed from lines t through z into column 8 and entered on line aa. Column 8 total and line aa must match, and the cell 8-aa total must equal the number of completed medical referrals (cell 8-q).","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},537738,1791696682,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":55,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":110},962090893057,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","ILLINOIS DEPARTMENT OF PUBLIC HEALTH HEARING CONSERVATION ANNUAL REPORT INSTRUCTIONS FOR COMPLETING FORM (HC-18)  \nSCREENING  \nEnter all screening data by preschool, in line a, and by school age, in lines b-o. All full-time special education class children must be entered on line o.  \nColumn  \n1. NUMBER SCREENED. Enter the total number of children screened.  \n2. NUMBER RESCREENED. Enter the total number of children rescreened.  \n3. NUMBER OF THRESHOLDS. Enter the total number of children who received threshold tests following second screening test failure. Include children upon whom you attempted thresholds, but were unable to obtain conclusive results.  \n4.  THRESHOLDS: KNOWN CASES AND MONITORING. Enter the total number of thresholdson children considered as known cases, e.g., children from watch lists, under physicians care, with hearing aids, etc.  \n5. NUMBER REFERRED. Enter the total number of children who met medical referral criteria and/or were referred because of obvious symptoms of ear pathology (i.e., draining ears) .  \nSum the data entered in each column, 1 through 5, and enter these sums on line p.  \nFOLLOW-UP RESULTS  \nEnter all follow-up results by school age, in column 6, and preschool, in column 7. Enter the sums of lines q and r in column 8. Sum columns 6, 7 and 8 and enter on line s. The sums of column 8 and line s must be equal and the number entered in cell 8-s must equal the total number of children referred, cell 5-p.  \nNumber of Completed Medical Referrals (q). Enter the total number of children for whom a treating physician’s report has been returned or information has been obtained verifying examination and diagnosis by a physician.  \nNumber of Referrals Not Completed (r). Enter the total number of children for whom no treating physician’s report has been received or information obtained verifying a medical examination and diagnosis.  \nDIAGNOSIS  \nEnter all diagnostic data by school age, column 6, and preschool, column 7. Enter the sums of line t through z in column 8. Sum columns 6, 7 and 8 and enter on line aa. The sums of column 8 and line aa must be equal and the number entered in cell 8-aa must equal the number of completed medical referrals, cell 8-q.  \nTotal Number of Children Found to Have. Enter the total number of children with a physician’s diagnosis on the following lines:  \nA.  CONDUCTIVE LOSSES  \n1. Canal obstructions (t)  \n2. Otitis Media (u)  \n3. Other (This classification includes allergies, cholesteatoma, otosclerosis, etc.) (v)  \nB. NON-ORGANIC (w) . children diagnosed with a non-specific hearing loss (no definitive pathology or specific cause indicated)  \nC.  SENSORINEURAL (x) . children diagnosed with a sensorineural loss (cochlear or eighth cranial nerve)  \nD.  MIXED (y) . children diagnosed with both a conductive and sensorineural hearing loss  \nE. NORMAL FINDINGS (z) . children diagnosed as normal hearing or for whom there is no pathological finding  \nPROGRAM  \nPrint or type agency name, i.e. , school district name and number, health department name or other agency name. Print or type agency address: number and street, city, ZIP code and county. Enter the name and telephone number of the individual submitting the report. Enter the date the report is submitted.  \nSubmit one cumulative annual report from each school district, health department or other agency responsible for hearing screening.  \nSubmit this report to the Department’s Vision and Hearing Program by June 30 of each year.  \nPLEASE TYPE OR PRINT LEGIBLY. CHECK ALL COMPUTATIONS. THIS FORM IS USED TO COMPILE STATEWIDE STATISTICS. THANK YOU FOR YOUR COOPERATION.  \nILLINOIS DEPARTMENT OF PUBLIC HEALTH  \nDIVISION OF HEALTH ASSESSMENT AND SCREENING  \nHEARING CONSERVATION ANNUAL REPORT JULY 1,   TO JUNE 30,    \n\n| | 1 Number Screened | 2 Number Rescreened | 3 Number of Thresholds | 4 Thresholds:\u003Cbr>Known Cases and Monitoring | 5 Number Referred | FOLLOW-UP RESULTS |  |  | 6 School\u003Cbr>-age | 7 Preschool | 8\u003Cbr>Total |\n| --- | ","cbCaiuZpTNKYc23w","https://ap.wps.com/l/cbCaiuZpTNKYc23w","pdf",168669,"English","# Instructions for Completing Form (HC-18)\n## Screening (Lines a–o)\n## Follow-Up Results (Columns 6–8)\n## Diagnosis (Lines t–aa)\n## Program and Submission Requirements","[{\"question\":\"What screening data must be entered for preschool and school-age children?\",\"answer\":\"Enter screening totals by preschool (line a) and school age (lines b–o). Full-time special education class children must be entered on line o.\"},{\"question\":\"How are follow-up results for referrals verified on the form?\",\"answer\":\"Follow-up outcomes are entered by school age (column 6) and preschool (column 7), then summed into column 8 and line s. The totals in column 8 and line s must match, and the cell 8-s total must equal the number of children referred (cell 5-p).\"},{\"question\":\"How are diagnostic categories recorded and checked for totals?\",\"answer\":\"Diagnostic data is entered by school age (column 6) and preschool (column 7), then summed from lines t through z into column 8 and entered on line aa. Column 8 total and line aa must match, and the cell 8-aa total must equal the number of completed medical referrals (cell 8-q).\"}]","ILLINOIS DEPARTMENT OF PUBLIC HEALTH - HEARING CONSERVATION ANNUAL REPORT - Instructions for Completing Form (HC-18) | PDF",1791605293]