Loading
Get Audiology Case History Form - University Of South Alabama - Faculty Ksu Edu
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the AUDIOLOGY CASE HISTORY FORM - University Of South Alabama - Faculty Ksu Edu online
Completing the Audiology Case History Form is an essential step to ensure that the audiologist understands your hearing and balance health needs. This guide will provide detailed instructions on how to fill out the form online, helping you navigate each section efficiently.
Follow the steps to successfully complete your audiology case history form.
- Begin by selecting the ‘Get Form’ button to access the Audiology Case History Form. This action will allow you to open the form in an online editor.
- In the Personal Information section, fill in your name, date of birth, address, and contact details. If you are completing this form for a child, provide the parent's first and last name as requested.
- Indicate your occupation and provide an emergency contact name and phone number. Additionally, note the referring physician's details and the reason for today's visit.
- Proceed to the Hearing, Balance & Health History section. Answer the questions regarding any current or past issues with ear blockage, pain, or hearing difficulties. Select 'Yes' or 'No' accordingly.
- If applicable, provide details regarding the duration and any treatments or surgeries related to ear infections. Document your family history of hearing loss if relevant.
- Complete the section concerning sensations related to imbalance, dizziness, or vertigo. Answer whether you experience these symptoms and describe them based on your situation.
- Continue by documenting any relevant general health conditions, medications, and your smoking status. Ensure you check all corresponding boxes to provide a comprehensive overview.
- Review the Consent for Payment, Treatment, and Personal Information sections carefully. Acknowledge understanding and provide consent by signing and dating the form.
- Once you have filled out all sections, review the completed form for accuracy. Save your changes, and if necessary, download, print, or share the form according to your needs.
Take the time to complete your Audiology Case History Form online to facilitate your hearing and balance health care.
Do not introduce the list with a colon. Simply begin the sentence as you normally would and then format each item onto a separate line. End each item with a semicolon, closing the second-to-last item with a semicolon, followed by the word “and” or the word “or”.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.