Get Cg6215.pdf. How To Calculate A Significant Threshold Shift - Uscg

This guide provides clear instructions on how to complete the CG6215.pdf, a form used to calculate a significant threshold shift in hearing. By following these steps, users can ensure accurate and efficient submission of the required information.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of the current audiogram at the top of the section labeled 'Current Audiogram'. Fill in the values for the left and right ear at 2000 Hz, 3000 Hz, and 4000 Hz, as indicated.
3. Proceed to the 'Baseline Audiogram' section and enter the date. Again, fill in the values for both the left and right ear at the specified frequencies.
4. After completing both audiogram sections, compute the summed values for each ear by adding the values you entered for 2000 Hz, 3000 Hz, and 4000 Hz.
5. Subtract the baseline audio sum from the current audio sum for each ear separately and document these values.
6. For step 2, take the left ear difference calculated in the previous step and divide this value by 3. Repeat this for the right ear.
7. Review the final results to determine if there has been a significant threshold shift, defined as either an average change of > ± 10 dB or a change of > ± 15 dB at certain frequencies.
8. Once all fields are filled out and checked for accuracy, users can save changes, download, print, or share the completed form as necessary.

Complete your form online for efficient processing and accurate record-keeping.