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Get ICSD Audiogram Form 2011-2024

Esponses in Bone Conduction, please write NR as noted in “Key to Symbols”. 7. Tympanometry - Record Tympanometry test results. See 2.3 above. 8. Reflexometry - Record Reflexometry test results. See 2.4 above. 9. Pure Tone Average – Add 500, 1000, 2000Hz and divided by three (3) for both air and bone testing results. 10. Type of Hearing Loss - Identify the type of hearing loss by placing ‘X’ accordingly as shown on the form for respective ear. 11. Comments - Please write comments as nee.

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