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HEARING SCREENING REPORT Name: D.O.B.: Location of Screening: Date of Test: Tested by 1. VISUAL INSPECTION Does child have ventilation tubes? ? Yes ? No If yes, indicate which ear(s) ? Right ? Left.

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Results of Testing:PASS: child must respond to each test frequency consistently at 20 dB HL in each ear. REFER: child does not respond at 20 dB HL at any one test frequency in either ear *

A hearing test is performed in a sound proof room. You will wear headphones or earplugs connected to a device that sends sounds of different volumes and pitches to one ear at a time. You will be asked to respond by raising your hand or pressing a button each time you hear a sound.

Pure tone audiometry screening should take place in a very quiet room. Perform an Environmental noise level check before performing screenings in any environment. Pause the screening if any distracting noise occurs. Perform thresholds only when there are hearing concerns or a child does not pass pure tone audiometry.

Find a quiet area to complete the hearing test. Choose if you prefer to use your device speakers or headphones. Headphones will provide you with more accurate results, and unlike device speakers, will test your right and left ears individually. Make sure the volume is on and set at a comfortable level.

This frequency range is critical for hearing and understanding speech and other sounds, and is the reason routine hearing screening uses 500, 1000, 2000, 4000 Hz, and 6000 Hz (ages 11 and older). Volume is the range of sound loudness, measured in decibels (dB). The greater the decibel number, the louder the sound.

A hearing screening is a simple pass or fail test. Its purpose is to determine if you have normal hearing or not. It usually consists of a series of beeps or tones at the limit of normal range to see if you are able to hear them.

We have two methods to test newborn hearing. One is called otoacoustic emissions and the other is auditory brainstem response. The OAE or otoacoustic emission, we put a small ear probe in the baby's ear canal and then play a sound and the ear sends back an echo.

If the test doesn't show a clear response from one or both of your baby's ears, your baby will need to have a second test. A 'refer' result requires the hearing screen to be repeated within a few weeks. It doesn't necessarily mean that your baby has a hearing problem.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232