1. (a) Newborns Subject to Screening. All newborns in Oklahoma shall have a Hearing Screening Procedure completed unless the parent refuses because of religious or personal objections.

2. (b) Screening Based on Birth Location. Requirements for the Hearing Screening Procedure are as follows:

   1. (1) Hospitals:

      1. (A) For facilities with a two-year average annual birth census of 15 or greater:

         1. (i) All infants will receive a physiologic and risk factor screening before discharge.
         2. (ii) Infants transferred to another facility will be screened by the receiving facility before discharge.

      2. (B) For facilities with a two-year average annual birth census of 14 or less:

         1. (i) All infants will receive a physiologic and risk factor screening before discharge if physiologic screening equipment is available.
         2. (ii) Infants transferred to another facility will be screened by the receiving facility before discharge.

         3. (iii) If physiologic screening equipment is not available, the infant will:

            1. (I) be screened for risk factors; and
            2. (II) receive a physiologic screening referral. A parent is encouraged to have the infant's screening occur within the first month of life.
   2. (2) Out-of-Hospital Births: All infants who are not born in a hospital will have their hearing screened within the first month of life. The infant's physician or other health care provider is responsible for completing the risk factor screening and for referring the infant to a health care facility with trained personnel and appropriate equipment for a physiologic screen or an audiologist.
3. (c) Refusal. A parent may refuse the newborn hearing screening on the grounds that such examination conflicts with their religious tenets and/or practices; refusal of hearing screening shall be indicated in writing utilizing the Newborn Screening Program Refusal Form provided by the Department. The Newborn Screening Program Refusal Form must be completed in its entirety.

4. (d) Physiologic Screening. A qualified and properly trained individual, as determined by the screening facility, will perform the Hearing Screening Procedure. The physiologic screening will include the use of at least one of the following:

   1. (1) Auditory Brainstem Response Testing (ABR);
   2. (2) Otoacoustic Emissions Testing (OAE); or
   3. (3) Any new or improved techniques considered appropriate by the Commissioner of Health.
5. (e) Sharing Results. The hospital or midwife will ensure that hearing screening results will be made available to the physician or other health care provider.

6. (f) Audiologist Referral. A newborn may be referred to an audiologist for a diagnostic hearing evaluation for these reasons:

   1. (1) They did not pass the hearing screening;
   2. (2) They passed the initial or subsequent hearing screening but, based on risk factors, is at risk for progressive or late onset hearing loss.
   3. (3) They did not pass the recommended six month follow hearing screening.

7. (g) Parent Education. Before discharge, a newborn's parent will receive the following information and materials:

   1. (1) results of the infant's hearing screening, which may include the following.

      1. (A) passed physiologic hearing screening
      2. (B) referred on physiologic hearing screening; or
      3. (C) considered as "at risk" for hearing loss
   2. (2) a copy and in-person review of the Newborn Hearing Screening Parent/Guardian Information Sheet; and
   3. (3) appropriate resource information to allow the newborn to receive the medical, audiologic, and other follow-up services as necessary.

8. (h) Reporting of Results and Quality Assurance. It is a hospital's responsibility to ensure that the newborn screening filter paper is correctly completed and that results are forwarded to the Oklahoma State Department of Health via the newborn screening filter paper, fax, or secure email within one week of performing the hearing screen. Efforts to ensure compliance includes the following:

   1. (1) adhere to instructions for completion of the hearing screening section located on the newborn screening filter paper kit
   2. (2) ensure hospital personnel involved in screening and/or reporting are properly trained using national and state resources such as in-service trainings, web trainings, or consultation with the Newborn Hearing Screening Program

   3. (3) designate a site coordinator to ensure:

      1. (A) every infant is screened,
      2. (B) each infant's filter paper has been fully completed for each infant; and
      3. (C) the detachable medical record copy is a permanent part of each infant's record.
9. (i) Screening Verification. Physicians, other health care providers, or local county health department staff who examine a child within the first three months of life will verify that the infant's hearing has been screened. Infants not screened will be referred to a health care facility with trained personnel and appropriate equipment for a physiologic screen or an audiologist.
10. (j) Reporting Follow-Up Evaluations. Health care facilities, physicians, audiologists or other health care providers involved in completing follow-up hearing screens or diagnostic evaluations will forward results and recommendations to the Oklahoma State Department of Health via fax or secure email within one week of performing the hearing screen or diagnostic evaluation.
11. (k) Reporting Standards. To facilitate the reporting of newborns and infants who have or are at risk for hearing loss, the reporting requirements will be designed to be as simple as possible and easily completed by nonprofessional and professional individuals involved in the program.
12. (l) Tracking System. The Oklahoma State Department of Health will utilize a tracking system to track infants identified at risk for hearing loss for a period up to one year in order to assure appropriate follow-up care.
13. (m) Data Reporting. The Oklahoma State Department of Health will compile and report data collected from hearing screening procedures at least annually and will share such information as directed by the Commissioner of Health.

Amended at 18 Ok Reg 99, eff 10-30-00 (emergency)

Amended at 18 Ok Reg 1719, eff 5-25-01

Amended at 37 Ok Reg 1416, eff 9-11-20

Amended at 38 Ok Reg 2038, eff 9-11-21