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 % CPOP LOG Name:_____________________________________________ CPOP Testing Log Sponsoring ENT: _______________________ 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60