Medical
Hearing Screening Form
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Hearing Screening Form

1
Patient check-in and identification
2
Verify patient's medical history
3
Explain the hearing screening procedure to the patient
4
Properly place earphones or insert earplugs
5
Perform pure tone audiometry
6
Record the patient's responses
7
Perform tympanometry
8
Record tympanometry results
9
Perform Otoacoustic Emissions (OAEs) test
10
Record the results of OAEs test
11
Approval: Audiologist review of test results
12
Discuss test results with the patient
13
Provide patient with a copy of the test results
14
Schedule follow-up appointment if necessary
15
Update patient's medical records
16
Patient check-out