Audiogram Form

audiogram form

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International Committee of Sports for the Dea OFFICIAL ...

This field is required and audiogram form must be completed three (3) months before the event. *Gender: *Which event? LEFT Data Entered By: RIGHT ICSD Audiologist:

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ILLINOIS DEPARTMENT OF PUBLIC HEALTH in cooperation with

... Satisfactory Unsatisfactory Responses (check one) Reliable Unreliable NOTE: This screening audiogram is plotted on ISO or ANSI reference levels.

www.idph.state.il.us

DD Form 2215, Reference Audiogram, January 2000

INSTRUCTIONS (Refer to DoD Component Instructions for additional guidance) PURPOSE: This form is used to record initial audiometric test results with which later audiometric test results can be compared (see DD Form 2216, "Hearing Conservation Data," to record periodic test results).

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How is hearing measured?

10 0 110 Audiogram How is hearing measured? Results of a hearing test are plotted on a chart called an Audiogram . The audiogram works like a graph to show the different levels (loudness) of hearing for different pitches (frequencies) of sound.

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AUDIOGRAM REGULATIONS

If athlete's audiogram form has not been submitted, a hearing test will be conducted at the site of the Games prior to receiving accreditation badge at the national deaf sports federation's expense. 5.2.

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DD Form 2216, Hearing Conservation Data, January 2000

15.c. Reference Audiogram Date. Enter year, month, and day reference test results were obtained. See DD Form 2215, "Reference Audiogram," or other appropriate source.

www.dtic.mil

Twenty years later: NEWCount-The-Dots method

Original Mueller and Killion Count-The-Dots audiogram form published in The Hearing Journal in 1990. 1 JANUARY 2010 • VOL. 63 • NO. 1 Page Ten THE HEARING JOURNAL 11.

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How to Read An Audiogram

All audiograms have an audiogram key , or legend at the bo om to remind the reader of the meaning of the symbols. Earphones are used to evaluate hearing of the outer, middle, and inner ear.

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International Committee of Sports for the Deaf

audiogram.xls. Family Name (Last ... Bone-masked O < X > NR COMMENTS: * AIR CONDUCTION & * BONE CONDUCTION AUDIOGRAM LEFT Ear Air Bone PURE TONE AVERAGE RIGHT Contra Ipsi Audiogram Form Revised: ...

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