Tone threshold audiometric test 21/02/2022 09:27:55

Name: Tn ISWADI HANSE

Surname: NoSurname
Date of birth: 1976/09/16
Age in years: 45
Company: Uniteda Arkanto, PT
Department: eMoyoDotNet
Job title:
Number:

ID/SS number: 02608248TA

Passport no.:
Significance: None

250 500 750 1k 1.5k 2k 3k 4k 6k 8 1012 250 500 750 1k 1.5k 2k 3k 4k 6k 8 1012
-20 -20
-10 -10
0 0
10 10
20 20
30 30
40 40
50 50
60 60
70 70
80 80
90 90
100 100
110 110

Left Right
125250 500 1k 2k 3k 4k 6k 8k 9k 10k 11.212.514k16k Frequencies 125250500 1k 2k 3k 4k 6k 8k 9k 10k11.212.514k16k

25 15 20 20 20 25 30 30 Air thresholds 70 60 45 45 40 45 65 70
-25 -25 -12 -23 -33 -32 -31 -30 Noise in ear canal -16 -14 -4 -7 -22 -24 -28 -28
-23 -24 -12 -34 -33 -32 -30 Noise for threshold-5dB -15 -9 -11 -26 -28 -28 -26

0 0 0 10 15 15 Bone thresholds 15 0 10 25 10 20
-21 -19 -6 -21 -32 -30 Noise in ear canal -16 -17 -2 -7 -29 -29
-22 -34 -31 Noise for threshold-5dB -15 -5 -7 -29 -28
Maximum masking

ZA PLH 12,6 Bone unmasked

Noise in ear canal
Binaural impairment 27 Noise for threshold-5dB
Patient response statistics
Pure tone avg. (500 1k 2k) n 110
Pure tone avg. (500 1k 2k)
Test re-test reliability (1st freq.)
18 Mean 512 50
False positive response % 16
Standard deviation 197

Audiogram notes:

Tn ISWADI HANSE NoSurname Pramita Manado wandy 01

Last calibration date: 21/10/2019

KUDUwave serial number: 0901-03516
Capturer of data version number: 2.12.19.0 Bone vibrator serial number: 70160012
Report software version: Sound booth: SANS 10182 Screening
Report generated on: 21/02/2022 09:40:07 Type of audiometer: Type 2
Unique Global Patient Number: C590BE5FAA1B4124B0A17554155C1E3B Test protocol: