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____________________ Location ______________________________________________ Examiner____________________ Otoscopic Impressions (WNL=within normal limits, R=right, L=left) External Ear: Cerumen: minimal moderate obstructed __________________ __________________ __________________ Audiometer __________________ HEARING SCREENING Pure Tone Air conduction Thresholds 250Hz 500Hz 1000Hz 2000Hz 4000Hz 6000HZ Right Left PASS FAIL RECOMMENDATIONS: ______________ Complete Audiometric Eva.

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