AAO-HNSF Certificate Program for Otolaryngology Personnel

Date Patient Initials History Ear Examination Tympanogram AC Thresholds BC Thresholds SRT WRS # Type 250, 500, 1000, 2000, 3000, 4000, 6000, 8000 250, 500, 1000, 2000, 3000, 4000, 6000, 8000 dB % 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 CPOP LOG Name:_____________________________________________ CPOP Testing Log Sponsoring ENT: _______________________