Hearing loss / Concern - unconfirmed / referred on screen (Audiology) (PAED)
-
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
- Suspicion of sudden sensorineural hearing loss
- Hearing loss with associated neurological signs e.g. facial nerve palsy, profound vertigo
-
| Category 1 (appointment within 30 calendar days) |
|
| Category 2 (appointment within 90 calendar days) |
|
| Category 3 (appointment within 365 calendar days) |
|
Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
2. Essential referral information Referral will be returned without this
- Current screening and/or diagnostic audiology reports (if applicable).
- Risk factors for hearing loss (if applicable); craniofacial; syndromes, family history
- Formal diagnosis of speech and language delay (if applicable);
- Comorbidities that put child at higher risk of developmental issues from hearing loss (if applicable)
- Details of ototoxic pharmaceutical agents and treatments (if applicable)
- Details of Medical Specialist concern
- Confirmation of OOHC (where relevant)
- Indigenous Status
3. Additional referral information Useful for processing the referral
- Previous ENT History (If applicable)
- Social modifiers i.e. effect on home schooling, out of home residence
- Previous audiology reports and/or audiograms (where available and not cause significant delay)
- Relevant diagnoses, co-morbidities, disabilities and medical issues
- Information about the nature of speech and language concern
- Otological history
- History including other medical, or developmental issues (school delays)
- Involvement of other health professionals
- Behavioural issues
- Other specialist of allied health services the child is currently under the care of (eg paediatrician or speech pathologist)
4. Request
-
Patient's Demographic Details
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
-
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
Last updated: 16 January 2025
© State of Queensland (Queensland Health) 2023
Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au1.