AAO-HNSF Certificate Program for Otolaryngology Personnel

CPOP Testing Log

Sponsoring ENT:

Name:

AC Thresholds R/L 250, 500, 1000, 2000, 3000, 4000, 6000, 8000

BC Thresholds R/L 250, 500, 1000, 2000, 3000, 4000, 6000, 8000

Tympanogram Type

SRT dB

WRS %

Type

Date

Patient Initials

History

Ear Examination

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