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Hearing screening form 2025

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The document is a hearing screening form for adults, designed to assess potential hearing loss and related issues. It includes sections for personal information, case history questions regarding hearing difficulties, visual inspection results, and pure-tone screening results. The form concludes with recommendations for further medical examination or management based on the screening outcomes.

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Click ‘Get Form’ to open the hearing screening form in the editor.
Begin by entering your name, birth date, and age in the designated fields. Select your gender by marking 'M' or 'F'.
Fill in the Screening Unit/Examiner and Calibration Date sections to provide context for your screening.
In the CASE HISTORY section, circle 'Yes' or 'No' for each question regarding your hearing health. This helps assess any potential issues.
For the VISUAL/OTOSCOPIC INSPECTION, indicate whether you pass or need a referral for both ears.
Complete the PURE-TONE SCREEN section by responding for each frequency tested in both ears.
Finally, review and add any recommendations or comments before saving your completed form.

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What are the guidelines for hearing screening?

All newborns should undergo hearing loss screening within their first month of life. Throughout childhood, the AAP recommends audiometry screening at ages 4, 5, 6, 8, and 10. During adolescence, the audiometry tests are recommended 3 times from ages 11 to 14, 15 to 17, and 18 to 21 years.

What is the 1 3 6 rule in audiology?

Its pretty easy to remember - One -screen for hearing loss before one month of age. Three - diagnose hearing loss before three months of age and six - enroll a child in early intervention programs before six months of age. Jordan: Pretty easy to remember - 1, 3, 6!

How do I fill out a hearing test form?

Fill in the patients personal information such as name, age, and contact details at the top of the form. Indicate the date of the screening on the designated line. Provide information regarding the patients medical history, particularly any previous hearing issues.

What is the 1 3 6 rule for hearing screening?

Recommended Early Hearing Detection and Intervention (EHDI) benchmarks include screening for hearing loss before 1 month of age, diagnostic evaluation before 3 months of age, and enrollment in early intervention before 6 months of age, known as the 1-3-6 benchmarks.

What is the 60 60 rule for hearing loss?

The idea behind the 60-60 rule is to only turn your music to 60 percent of its total volume level and listen to it for no more than 60 minutes per day. Noise-canceling headphones can be safer than earbuds because they reduce exterior sounds that may cause you to turn up the volume past safe levels.

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How do you get hearing screening?

Children get screenings at school or at the doctors office. Adults can go to the doctor or local health fairs for a screening. You should ask your doctor for a hearing screening if you have concerns about your or your childs hearing. An audiologist can give you a more complete hearing test if you fail the screening.

How do you document a hearing screening?

For each ear, note the results of the pure tone hearing screening and tympanometry (if performed). Document each frequency screened in a manner that indicates the decibel it was screened at and whether the result was a PASS or REFER.

Hearing screening form 2025

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What are the guidelines for hearing screening?

What is the 1 3 6 rule in audiology?

How do I fill out a hearing test form?

What is the 1 3 6 rule for hearing screening?

What is the 60 60 rule for hearing loss?

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How do you get hearing screening?

How do you document a hearing screening?

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