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AUDIOGRAM State of Illinois Illinois Department of Public Health Date Test Number Name (last) (first) Birth date Sex Grade (initial) (month) / (day) / (year) Parent/Guardian Phone ( ) (last) (first).

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A pure tone audiometry test measures the softest, or least audible, sound that a person can hear. During the test, you will wear earphones and hear a range of sounds directed to one ear at a time. The loudness of sound is measured in decibels (dB).

To calculate your hearing disability, take the smaller figure from Step 2 (your better ear) and multiply it by 5. Add this to the figure of your worse ear from Step 2. Add these two numbers together and divide the result by 6. That is your hearing handicap as a percentage.

An audiogram is a graph that shows the softest sounds a person can hear at different pitches or frequencies. The closer the marks are to the top of the graph, the softer the sounds that person can hear. Where the patient's results fall on the audiogram indicate the different degrees of hearing loss.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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