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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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© 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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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