OHIO AGENCY DIRECTORY APPLICATION

If you would like your Agency included in OSLHA's Agency Directory, please complete the following information. Your submission will be reviewed.  If approved, your Agency will be added, or updated, to the Agency Directory within 10 working days of submission.   If your Agency has multiple locations/sites, complete a separate form for each location.  Your listing does not constitute an endorsement by OSLHA.

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Agency Name:
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Agency Contact:
A/C  Phone:  Ext:
Fax: A/C   Phone:
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For public inquiries regarding your agency
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Please enter ALL the services your agency provides on the following Speech-Language Pathology and Audiology Procedure Lists
(taken from the ASHA Preferred Practice Patterns publications):

SPEECH-LANGUAGE PATHOLOGY
III. Procedure Code List
  01.0   Audiologic Screening - SLP
  02.0   Speech Screening - SLP
  03.0   Language Screening - SLP
  04.0   Swallowing Screening
  05.0   Follow-up Procedures
  06.0   Consultation - SLP
  06.1   Prevention - SLP
  07.0   Counseling - SLP
  08.0   Aural Rehabilitation Assessment - SLP
  09.0   Aural Rehabilitation - SLP
  10.0   Product Dispensing - SLP
  11.0   Product Repair/Modification - SLP
  12.0   Prespeech,Prelanguage, and Language Assessment for Infants and  Toddlers
  12.1   Language Assessment for Children and Adolescents
  12.2   Language Assessment for Adults
  12.3   Augmentative and Alternative Communication (AAC) Assessment
  12.4   Cognitive-Communication Assessment
  12.5   Articulation/Phonology Assessment
  12.6   Fluency Assessment
  12.7   Voice Assessment
  12.8   Resonance and Nasal Airflow Assessment
  12.9   Swallowing Function Assessment
  12.10  Orofacial Myofunctional Assessment
  13.0   Comprehensive Speech-Language Pathology Assessment
  14.0   Prosthetic/Adaptive Device Assessment
  15.0   Speech-Language Treatment / Instruction / Early Intervention
  15.1   Swallowing Function Treatment
  15.2   AAC System and/or Device Treatment / Orientation
  15.3   Prosthetic / Adaptive Device Treatment / Orientation
  15.4   Orofacial Myofunctional Treatment
  15.5   Fluency Treatment
  15.6   Voice Treatment
  15.7   Treatment of Central Auditory Procewssing Disorders (CAPD) Adults & Children - SLP
  16.0   Speech-Language Instruction
  17.0   Communication Instruction

AUDIOLOGY
III. Procedure Code List
  01.0   Audiologic Screening  (by Audiologists)
  02.0   Speech Screening  (by Audiologists)
  03.0   Language Screening  (by Audiologists)
  04.0   Follow-up Procedures  (by Audiologists)
  05.0   Consultation  (by Audiologists)
  06.0   Prevention  (by Audiologists)
  06.1   Occupational and Environmental Hearing Conservation (OHC)
  07.0   Basic Audiologic Assessment
  08.0   Advanced Audiologic Assessment
  09.0   Pediatric Audiologic Assessment
  10.0   External Ear Canal (EAC) Examination and Cerumen Management
  11.0   Electrodiagnostic Test Procedures
  12.0   Auditory Evoked Response Assessment
  13.0   Neurophysiologic Intraoperative Monitoring
  14.0   Audiologic (Aural) Rehabilitation Assessment  (by Audiologists)
  15.0   Audiologic (Aural) Rehabilitation  (by Audiologists)
  16.0   Assessment of Central Auditory Processing Disorders (CAPD) Adults and Children
  16.1   Treatment of CAPD ion Adults and Children (by Audiologists)
  17.0   Counseling  (by Audiologists)
  18.0   Balance System Assessment
  19.0   Hearing Aid Fitting
  20.0   Product Dispensing  (by Audiologists)
  21.0   Product Repair / Modification  (by Audiologists)
  22.0   Assistive Listening System / Device Selection
  23.0   Sensory Aids Assessment

                                                                                                                              

Notes/Remarks:

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