Palau Birth Registry

🔍

Mother Lookup

Find an existing mother to register a new birth

💡 Use this lookup to find an existing mother and pre-fill her information for a new birth registration.

Mother Last Name

Mother First Name

Mother Hospital Number

Enter mother's name or hospital number to search.

🤰

Birth Registration Form

Complete all applicable sections

Mother Demographics

Delivery Date

Mom Hospital Number *

Mom Last Name *

Mom First Name *

Mom Middle Name

Date of Birth

Age

Education

Marital Status

Nationality

Other Nationality

Ethnicity

Race

State

Hamlet

Occupation

Home Phone

Mobile Phone

Delivery Details

Place of Birth

Other Place

Birth Attendant

Other Attendant

Number of ANC

AOG (Weeks)

AOG (Days)

LMP Date

Date of First Prenatal Visit

Date of Last Prenatal Visit

Prenatal Care Began

Total Prenatal Visits

Birth Interval (Months)

Birth Interval (Years)

Gravida

Parity

Accessed Prenatal Care From

No. of Previous Live Births

No. of Pregnancy Outcomes (losses/ectopic)

Spontaneous Losses

Induced Losses

Ectopic Pregnancies

Mother Measurements

Pre-Pregnancy Weight (lbs)

Pregnancy Weight (lbs)

Height (Feet)

Height (Inches)

BMI

BMI Category

Systolic BP

Diastolic BP

BP Category

Protein

Glucose

Risk Factors

Pre-Pregnancy ATOD Use

ATOD Use During Pregnancy

Infections Present/Treated During Pregnancy

Other Infection

Common Labor and Delivery Complications

Other Labor Complication

Method of Delivery

Forceps Attempted (Unsuccessful)?

Vacuum Extraction Attempted (Unsuccessful)?

Fetal Presentation

Method of Delivery

Newborn Details

Newborn Hospital Number

Birth Date *

Birth Weight (grams) *

Weight Category

Sex *

Breastfed?

Plurality

Other Birth Type

Birth Order

APGAR at 5 Minutes

APGAR at 10 Minutes

Birth Outcome *

Abnormal Conditions of the Newborn

Other Abnormal Condition

Congenital Anomalies

Other Congenital Anomaly

Additional Notes

👂

Newborn Hearing Screening

Summary from birth registry & screening records

Loading summary…

🏥

Hospital Hearing Screening Entry

OAE & ABR — per JCIH 2019 guidelines (1-3-6 benchmarks)

Link to Birth Record

Mother's Hospital Number

Mother's Name

Delivery Date

Maternal Demographics (auto-filled)

Contact Numbers

Maternal Age

Education

Ethnicity / Race

Newborn Demographics (auto-filled)

Newborn Hospital Number

Sex

Date of Birth

Screening Settings

Screening Type

Nursery Setting

Screening Site

Specify Site

JCIH Risk Indicators (check all that apply)

Family history of childhood hearing loss NICU stay ≥ 5 days Hyperbilirubinemia (exchange transfusion) Ototoxic medications (aminoglycosides/diuretics) Congenital CMV Craniofacial anomalies Syndrome associated with hearing loss Postnatal culture-positive infections/meningitis ECMO Mechanical ventilation Low Apgar score (0–4 at 1 min / 0–6 at 5 min) Birth weight < 1500 g Caregiver concern about hearing

1st OAE Test

Test Date

Provider Code

Left Ear

Right Ear

2nd OAE Test (if applicable — inpatient rescreen)

Test Date

Provider Code

Left Ear

Right Ear

ABR Test (recommended for NICU infants per JCIH 2019)

Test Date

Provider Code

Left Ear

Right Ear

🩺

Clinic Follow-up Screening

Follow-up for referred newborns, or initial screening for those missed at nursery

For referred newborns: use the ✏️ Edit button in the records table, or enter the Mother's Hospital #.
For newborns not screened at the nursery: enter the Mother's Hospital # — a new initial screening record will be created.

Link to Birth / Screening Record

Mother's Hospital #

Mother's Name

Baby DOB

Screening Type

Type

OAE Test

Screening Site

Specify Site

Test Date

Provider Code

Left Ear

Right Ear

ABR Test

Test Date

Left Ear

Right Ear

🔬

Diagnostic Audiological Evaluation

For referred newborns — hearing loss type, laterality & severity

Complete this section for newborns who received a final "Refer" result after screening. Link to a screening record using the Mother's Hospital #.

Link to Screening Record

Mother's Hospital #

Mother's Name

Baby DOB

Evaluation Details

Evaluation Date

Evaluated by (Provider)

Evaluation Site

Age at Diagnosis (months)

Diagnosed Before 3 Months?

Diagnosis Result

Diagnosis Outcome

Laterality

🧒

Early Intervention (Part C) Tracking

JCIH 1-3-6 benchmark — enrollment, services & follow-up

Track early intervention referral, enrollment, and services for infants diagnosed with hearing loss. Links to an existing screening record.

Link to Screening Record

Mother's Hospital #

Mother's Name

Baby DOB

Referral

Referral Date

Referred By

Referral Source

Enrollment

EI Status

Enrollment Date

EI Program / Provider

Amplification

Hearing Aid Fitted?

Hearing Aid Fit Date

HA Fitted Within 1 Month of Dx?

Cochlear Implant?

CI Date

Services (check all that apply)

Audiology Services Speech-Language Therapy Sign Language Instruction Family Counseling / Support Developmental Therapy Other Services

Follow-up Notes

📋

Hearing Screening Records

All recorded screening results

Mother Name	Baby DOB	Sex	Site	1st OAE L	1st OAE R	2nd OAE L	2nd OAE R	ABR L	ABR R	Final	Diagnosis	Actions
No hearing screening records yet.

📥

Export Data

Download birth registry & hearing screening data

Date Range Filter

From Date

To Date

Birth Registry

Hearing Screening

⚙️

Manage Users

Add or remove user accounts

Add New User

Full Name *

Email *

Password *

Role

Provider Code *

Module Access

Birth Registry Hearing Screening

Current Users

Name	Email	Role	Access	Provider Code	Action

Birth Registry

Mother Lookup

Birth Registration Form

Newborn Hearing Screening

Hospital Hearing Screening Entry

Clinic Follow-up Screening

Diagnostic Audiological Evaluation

Early Intervention (Part C) Tracking

Hearing Screening Records

Export Data

Manage Users

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