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  • Audiogram

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    Mellyza Rahmi
    7 views2 pages
    This document appears to be an audiometry test report. It includes sections for patient information like name, age, gender and address. There are also sections to record results of impedance tympanometry, reflexometry and pure tone audiometry tests for both the right and left ears using air and bone conduction. The conclusion section is blank. The document is dated 2017 and includes spaces for an electronic signature.

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    audiogram.docx

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    This document appears to be an audiometry test report. It includes sections for patient information like name, age, gender and address. There are also sections to record results of impedance tympanometry, reflexometry and pure tone audiometry tests for both the right and left ears using air and bone conduction. The conclusion section is blank. The document is dated 2017 and includes spaces for an electronic signature.

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    © All Rights Reserved
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    7 views2 pages

    Audiogram

    Uploaded by

    Mellyza Rahmi
    This document appears to be an audiometry test report. It includes sections for patient information like name, age, gender and address. There are also sections to record results of impedance tympanometry, reflexometry and pure tone audiometry tests for both the right and left ears using air and bone conduction. The conclusion section is blank. The document is dated 2017 and includes spaces for an electronic signature.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 2

    No RM : ..

    Perusahaan :
    ..
    Tanggal : . Jenis kelamin :
    ..
    Nama : . Alamat :
    ..
    Umur : handphone :
    ..

    *IMPEDANCE TYMPANOMETRY
    Ear Canal Peak Gradient Pres.
    Vol. Comp. Peak

    RIGHT

    LEFT

    *REFLEXOMETRY
    Side Equals Probe Ear
    RIGHT Stim 500 1000 2000 4000

    Ipsi
    THRESHOLD LEVEL DECIBELS
    (dB) Contra

    LEFT Stim 500 1000 2000 4000

    Ipsi

    Contra

    PURE TONE AVERAGE


    (500-1000-2000 -4000 Hz )
    Ear Air Bone

    RIGHT

    LEFT

    ICSD HOME OFFICE USE ONLY


    ID:
    Data Entered By:
    ICSD Audiologist:

    Kesimpulan :

    Duri,.............................2017

    (_____________________)

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