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What is Audiogram Examination Form Template about?

This document is a form for an audiogram examination from Dr. Zainoel Abidin General Hospital in Banda Aceh. It includes fields for patient identity information like name, age, gender, and contact details. The results section charts hearing levels in decibels at different frequencies from 250Hz to 8kHz for both ears. Symbols are provided in a table for noting the results. Space is allocated for the examining doctor to provide a conclusion and recommendation.

Author

irnawati

Language

EN