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SimuCase TM 2009HEARING SCREENING FORM STUDENTS NAME GRADEKara LynnSCHOOL YEAR20082009PreschoolHEARING CRITERIA: Puretone AudiometryTympanometry. A student fails the screening test if he/she does.

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How to fill out the Hearing Screening Form - SpeechPathology.com online

Filling out the Hearing Screening Form is crucial for assessing a student's auditory health. This guide will assist you through each section of the form, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to complete the form with ease.

  1. Click ‘Get Form’ button to obtain the form and open it for editing.
  2. Begin by entering the student’s name in the designated field at the top of the form. Ensure the spelling is correct to avoid any confusion.
  3. Next, indicate the grade of the student in the appropriate section. This information is essential for contextualizing the hearing screening results.
  4. Fill in the school year in the designated field. This helps in tracking the screenings conducted over different academic years.
  5. In the hearing criteria section, make sure to accurately document the results of the pure-tone audiometry and tympanometry tests for each ear. Record any passed or failed results along with the corresponding frequencies.
  6. Provide remarks in the remarks section for both ears if necessary. This might include notes on tuition or recommendations for follow-up actions.
  7. At the conclusion of the form, the examiner should sign and print their name to authenticate the results and indicate who conducted the screening.
  8. Once all fields are completed, review the form for any errors. After ensuring accuracy, you can save changes and choose to download, print, or share the document as needed.

Take the next step in managing your documentation and complete the Hearing Screening Form online today!

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Hearing tests check a person's ability to hear the loudness and pitch of sounds. The results are charted on a graph (audiogram) to help pinpoint the severity and causes of hearing problems. Tests include pure tone audiometry, using an audiometer, and speech discrimination tests.

Earphones will be placed on your head. You will be asked to sit still and not talk. The earphones are connected to a machine that will deliver the tones and different sounds of speech to your ears, one ear at a time. The audiologist will ask you to raise your hand when you hear a sound.

Document each frequency screened in a manner that indicates the decibel it was screened at and whether the result was a PASS or REFER. Use consistent notations with a key indicating which symbols or words denote PASS and REFER so that results are clear to caregivers/guardians and providers.

Wearing the audiometer earphones, the screening frequency pure tones (1000 Hz, 2000 Hz, and 4000 Hz) should be heard at a level of 10 dB (screening level for a child is 20 dB and for adults is 25 dB). If the screener cannot hear the tones at 10 dB at each screening frequency, do not screen in that environment.

A screening failure was defined by the guidelines as the inability to detect 1 or more frequencies at 20-dB HL in either ear. The guidelines recommended tympanometry on any child who failed a screening, with appropriate follow-up recommendations based on the tympanometry results.

Document each frequency screened in a manner that indicates the decibel it was screened at and whether the result was a PASS or REFER. Use consistent notations with a key indicating which symbols or words denote PASS and REFER so that results are clear to caregivers/guardians and providers.

For example, take the term “hearing test;” when is a hearing test not a hearing test? The answer is when it's a hearing screening. A hearing screening is the most basic form of testing your ability to hear. A hearing screening is generally a preliminary test to see if more in-depth testing needs to be done.

You'll be shown a graph that indicates your level of hearing sensitivity with frequencies (also called pitch) in Hertz along the top of the graph, and sound levels in decibels along the left side of the graph. Typically, audiograms test frequencies between 250Hz and 8,000 Hz.

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