(All fields required)
Please enter a valid email.
Please enter your name.
What is : (So we know you are human.)
Please supply the correct answer.
When a child is diagnosed with hearing loss, her audiologist should contact CCHAT. We will facilitate shipment of a hearing aid directly to the practicing audiologist. CCHAT has partnered with Phonak and Oticon to provide patients with hearing aids.
If you have a patient who is interested in seeking financial assistance through CCHAT, submit a completed Provider Application (if a new provider) as well as a completed Hearing Aid Request form. You will need the following information:
1. The patient’s most current audiogram, taken within the last six months
2. Other tests that may be needed for diagnosis
3. Physician visit forms (if applicable)
4. Your Ohio license number
Once the hearing aid order has been placed, the CCHAT coordinator may contact the dispensing audiologist to complete additional forms needed for the CCHAT applicant.
1. Please instruct your patient’s guardian to visit our website, (use the following shortcut: www.cincinnatichildrens.org/cchat). The guardian will need to visit the Patient Education page to complete the application process. The hearing device will not be ordered until the guardian contacts the CCHAT coordinator.
2. After the guardian has contacted the CCHAT coordinator, the next steps for application process will be discussed and the hearing aid order will be placed.
3. The hearing device will be sent to the practice within 48 hours after the guardian has contacted the CCHAT coordinator.
4. The audiologist will be reimbursed at the time of hearing aid funding.
The following forms can be downloaded in portable document format (.pdf). You must have Adobe Reader installed on your computer to read the files.
Learn more about the Cincinnati Children’s Hearing Aid Trust (CCHAT), including information for patients and families.
Complete our online form to give to the Cincinnati Children’s Hearing Aid Trust (CCHAT).
3333 Burnet Avenue, Cincinnati, Ohio 45229-3026 | 1-513-636-4200 | 1-800-344-2462 | TTY:1-513-636-4900
New to Cincinnati Children’s or live outside of the Tristate area? 1-877-881-8479
© 1999-2016 Cincinnati Children's Hospital Medical Center