Get Blank Audiometric Screening Form Pdf

Filling out the Blank Audiometric Screening Form Pdf online can be straightforward with the right guidance. This form is essential for recording audiometric screening results and ensuring proper referrals for further evaluation.

Follow the steps to fill out the Blank Audiometric Screening Form Pdf online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling in the Name and Date of Birth fields. Ensure this information is accurate to maintain consistency across records.
3. Complete the Site and Date fields. Specify the location where the screening took place and the date of the examination.
4. Record the audiometric results for the Right Ear and Left Ear in the respective sections. Fill in the data for each frequency (1000, 2000, 3000, 4000 Hz). Use check marks to indicate a response at the level of 25dB, and an 'F' to denote no response.
5. Include any relevant comments in the Comments section to provide context or additional observations from the screening.
6. Specify the referral details in the Referred To section, indicating the next course of action based on screening results.
7. In the Parent Authorization section, the parent or guardian should sign to authorize the sharing of findings with the Head Start Nurse designated on the form.
8. Once all sections are completed, review your entries for accuracy. Save the form to keep your changes and download it if necessary.
9. Print the form for any required physical copies or share it electronically with relevant parties as described in the distribution guidelines.

Start filling out your Blank Audiometric Screening Form Pdf online today for a smooth and efficient process.