Title Page
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Client Name
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Client ID (C-Number)
Checklist Instructions
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Checklist is to be completed by Clinicians when reviewing their own client files.
Clinicians should review 6 client files (3 new and 3 return HSP clients who have completed a claimable assessment (600/800) and received a full fitting program) since 1/9/22.
Documentation should be reviewed from the DM files tab. If missing documentation is identified, check the compliance folder &/or DIGIform portal to determine if draft form is available.
The review should be undertaken authentically. This is a self-learning activity - use the opportunity to ensure you are compliant with legislative, clinical and business requirements.
The checklist verifies against specific HSP & best practice requirements .
Check the evidence and documentation on the file against each requirements. Choose if the requirement is applicable to the client. Read each question:
• Choose 'YES ' response if client records clearly document the requirement
• Choose 'NO' response if client records do not or do not fully document the requirement
• Choose 'N/A' if not relevant to client
Further information may be found in the HSP Schedule of Service Items, by referencing the applicable Audika policy /Work Instruction (if applicable), or from a Clinical Trainer.
The last section 'Clinician Comments' provides space for the Clinician to provide comment on individual client files (if applicable)
Clinician Self File Review
File Review
Legislative Requirements
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All relevant legislative requirements must be met for compliance
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Client consent signed AND dated (on Preassessment form)? <br> <br> Refer to P02C002, Adult Clinical Consent Policy; W02A025, HSP Client Consent Requirements
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Relocation consent signed AND dated (if applicable) <br> <br> Refer to W02D007, Managing HSP Client Relocations & W02D047, Managing HSP Relocations In for further information
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Does the client qualify for Specialist Services?<br><br>Refer to W02A014, Specialist Services Notification Requirements for further information
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Has the portal been updated?
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Has the discussion and client preference been documented?
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Do Minimum Hearing Loss Threshold (MHLT) requirements apply? (3FAHL <23 dB in either ear)<br><br>Refer to W02C048 , Minimum Hearing Loss Threshold for further information
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Has the Minimum Hearing Loss Threshold (MHLT) form been completed, documenting the exemption criteria?
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Has the WANT form been completed with a total score of ≥ 5, signed AND dated prior to fitting?
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Have fully subsidised device options been offered?<br>Ensure device model and style are also documented<br><br>Refer to P02A002, Best Practice Clinical Standards –Hearing Rehabilitation (Hearing Devices) for further information<br>
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Telecoil information provided, and where fitted device(s) do not have telecoil, client’s decision to opt out is documented?<br><br>Refer to P02A002, Best Practice Clinical Standards –Hearing Rehabilitation (Hearing Devices)
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Quote & Purchase Terms Agreement (QAPT) signed AND dated prior to fitting, for all devices fitted?<br><br>- Devices on QAPT must exactly match devices provided <br>- QAPT must include the correct maintenance co-payment amount.<br><br>P02D010, Quote and Purchase Terms Policy for further information
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Eligibility Criteria for Refit met and clearly documented? (if applicable)<br><br>Refer to W02C008, Refit and Replace (HSP Clients) for further information<br>
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Eligibility Criteria for Refit worksheet uploaded?
Other Critical HSP Requirements
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Fitted devices have minimum 10dB reserve gain at 500-4k Hz (or evidence of HSP exemption on file)?<br><br>Refer to P02A002, Best Practice Clinical Standards –Hearing Rehabilitation (Hearing Devices); W02C063, HSP -Determine Sufficient Gain for further information
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Private Services & Device Acknowledgement form completed? <br>(Applicable where Client has paid for any private services, accessories, recharge dock or private devices)<br><br>Note: If accessories or recharge docks are funded by a 3rd party, e.g. Home Care Package or DVA, a private services form is not required. <br><br>Refer to W02C020, Devices Privately Purchased by HSP Clients for further information<br>
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Were SMART COSI goals established, reviewed AND dated? <br> Refer to P02A002, Best Practice Clinical Standards –Hearing Rehabilitation (Hearing Devices)
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Has aided speech testing been completed?<br><br>Refer to P02A002, Best Practice Clinical Standards –Hearing Rehabilitation (Hearing Devices)
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Has device usage been reviewed?<br>(Documented either by data logging or reported usage)<br><br>Refer to P02A002, Best Practice Clinical Standards –Hearing Rehabilitation (Hearing Devices)
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Has the Maintenance Agreement been signed AND dated between fitting and follow up?<br><br>Refer to W02C044, Maintenance Claim Form and Maintenance Agreement Requirements
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If the client does not have Maintenance, has their decision to opt out been documented?
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Are all claim forms uploaded correctly?<br> All claims forms must be signed and have the correct dates. Fitting forms must also have the correct device code and cost to client.
Other Forms and Supporting Documentation
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Has the Preassessment form been uploaded? <br>
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Has an Assessment form been uploaded?
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Has a Rehabilitation Program & Device Selection form been uploaded? Either standalone or as part of an Assessment/Review form
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Have COSI been uploaded?
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Has the Fitting form been uploaded?
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Has the Follow Up form been uploaded?
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Has the Audiogram .xml file been uploaded to the Audiograms tab in DM?
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Has the Audiogram .pdf been uploaded to the Files tab in DM?
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Has the GP report been uploaded?
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Have the device settings been uploaded?
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Has the aided speech assessment been uploaded?
Clinical Best Practice Requirements
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Complete clinical & audiological history (on preassessment &/or assessment form)? <br> <br>Refer to W02C054, Audiological Case History for further information
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Otoscopy completed at assessment and observations documented?
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Otoscopy completed at fitting and observations documented?
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Accurate & complete assessment performed? <br> <br>(Including pure tone audiometry, tympanometry [unless contraindicated] & unaided speech) <br> Refer to P02A001, Best Practice Clinical Standards –Audiological Assessment for further information
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Where referral requirements are met, report sent to medical practitioner and written medical clearance received prior to fitting if necessary. <br> Refer to P02A005, Best Practice Clinical Standards Clinical Referral & F02C008, Referral Requirements Summary Sheet for further information
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Justification of device recommendation and reasons for client choice documented <br> <br>Refer to P02A002, Best Practice Clinical Standards –Hearing Rehabilitation (Hearing Devices)
Digital Processes to Support Ongoing Client Care
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Appointment 'Outcome Notes' completed with summary of service provided and further actions?
Clinician Declaration
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I, the Clinician, understand that while this self-review is an educational activity, I will resolve any potential non-compliances detected in the process.
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Additional Comments
