DVBCWIO1.m

DVBCWIO1 ;ALB/JFP AUDIO WKS TEXT - 1 ; 12 FEB 1998

 ;;2.7;AMIE;**16**;Apr 10, 1995

 ;

TXT ;

 ;;A.  Review of Medical Records:

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;      Comment on:

 ;;        1.  Chief complaint.

 ;;        2.  Situation of greatest difficulty.

 ;;        3.  Pertinent service history.

 ;;        4.  History of military, occupational, and recreational noise

 ;;            exposure.

 ;;        5.  Tinnitus - If present, state:

 ;;              a.  Date and circumstances of onset.

 ;;              b.  Whether it is unilateral or bilateral.

 ;;              c.  Whether it is constant or periodic (indicate

 ;;                  frequency).

 ;;              d.  Severity and effect on daily life.

 ;;              e.  Veteran's account of loudness or pitch.

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;    1.  Measure puretone thresholds in decibels at the indicated

 ;;        frequencies (air conduction):

 ;;

 ;;    = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = = 

 ;;    A*    B    C    D    E    **       A*   B    C   D    E     **

 ;;    500|1000|2000|3000|4000|average   500|1000|2000|3000|4000|average

 ;;       |    |    |    |    |             |    |    |    |    |

 ;;  

 ;;    *  The puretone threshold at 500 Hz is not used in determining the

 ;;       evaluation but is used in determining whether or not a ratable 

 ;;       hearing loss exists.

 ;;    ** The average of B, C, D, and E.

 ;;

 ;;    2.  Speech Recognition Score:

 ;;        a.  Maryland CNC word list  _____% right ear _____% left ear. 

 ;;        b.  W-22 word list (only if specifically requested by the 

 ;;            regional office).       _____% right ear _____% left ear.

 ;;

 ;;    3.  When only puretone results should be used to evaluate hearing

 ;;        loss, the Chief of the Audiology Clinic should certify that 

 ;;        language difficulties or other problems make the combined use

 ;;        of puretone average and speech discrimination inappropriate.

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;    1.  Include results of all diagnostic and clinical tests conducted

 ;;        in the examination report.

 ;;

 ;;E.  Diagnosis:

 ;;    1.  Summary of audiologic test results.

 ;;    2.  Note whether audiologic results indicate an ear or hearing 

 ;;        problem that requires medical follow-up or a problem which, if

 ;;        treated, might cause a change in hearing threshold levels.

 ;;

 ;;

 ;;Signature:                                        Date:

 ;;END

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---DVBCWIO1   2592     printed  Feb 18, 2025@23:18:26                                                                                                                                                                                                    Page 2

DVBCWIO1  ;ALB/JFP AUDIO WKS TEXT - 1 ; 12 FEB 1998

 +1       ;;2.7;AMIE;**16**;Apr 10, 1995

 +2       ;

TXT       ;

 +1       ;;A.  Review of Medical Records:

 +2       ;;

 +3       ;;B.  Medical History (Subjective Complaints):

 +4       ;;      Comment on:

 +5       ;;        1.  Chief complaint.

 +6       ;;        2.  Situation of greatest difficulty.

 +7       ;;        3.  Pertinent service history.

 +8       ;;        4.  History of military, occupational, and recreational noise

 +9       ;;            exposure.

 +10      ;;        5.  Tinnitus - If present, state:

 +11      ;;              a.  Date and circumstances of onset.

 +12      ;;              b.  Whether it is unilateral or bilateral.

 +13      ;;              c.  Whether it is constant or periodic (indicate

 +14      ;;                  frequency).

 +15      ;;              d.  Severity and effect on daily life.

 +16      ;;              e.  Veteran's account of loudness or pitch.

 +17      ;;

 +18      ;;C.  Physical Examination (Objective Findings):

 +19      ;;    1.  Measure puretone thresholds in decibels at the indicated

 +20      ;;        frequencies (air conduction):

 +21      ;;

 +22      ;;    = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = = 

 +23      ;;    A*    B    C    D    E    **       A*   B    C   D    E     **

 +24      ;;    500|1000|2000|3000|4000|average   500|1000|2000|3000|4000|average

 +25      ;;       |    |    |    |    |             |    |    |    |    |

 +26      ;;  

 +27      ;;    *  The puretone threshold at 500 Hz is not used in determining the

 +28      ;;       evaluation but is used in determining whether or not a ratable 

 +29      ;;       hearing loss exists.

 +30      ;;    ** The average of B, C, D, and E.

 +31      ;;

 +32      ;;    2.  Speech Recognition Score:

 +33      ;;        a.  Maryland CNC word list  _____% right ear _____% left ear. 

 +34      ;;        b.  W-22 word list (only if specifically requested by the 

 +35      ;;            regional office).       _____% right ear _____% left ear.

 +36      ;;

 +37      ;;    3.  When only puretone results should be used to evaluate hearing

 +38      ;;        loss, the Chief of the Audiology Clinic should certify that 

 +39      ;;        language difficulties or other problems make the combined use

 +40      ;;        of puretone average and speech discrimination inappropriate.

 +41      ;;

 +42      ;;D.  Diagnostic and Clinical Tests:

 +43      ;;    1.  Include results of all diagnostic and clinical tests conducted

 +44      ;;        in the examination report.

 +45      ;;

 +46      ;;E.  Diagnosis:

 +47      ;;    1.  Summary of audiologic test results.

 +48      ;;    2.  Note whether audiologic results indicate an ear or hearing 

 +49      ;;        problem that requires medical follow-up or a problem which, if

 +50      ;;        treated, might cause a change in hearing threshold levels.

 +51      ;;

 +52      ;;

 +53      ;;Signature:                                        Date:

 +54      ;;END