DINAS KESEHATAN KOTA DKI JAKARTA,
RUMAH SAKIT UMUM DAERAH BUDHI ASIH
JL. DEW SARTICA CAWANG I 200 TELP. 8090282
AUDIOGRAM (No )
Name Na. Wut Maman Age 20 © Examiner Ves Vio
Diagnosis Date 20 fia / 20/8
ight Ear
mastingnoie PAR — 4p Et,
BONE 4B COC
band Tone
_ [Eeey $00 4 1000 2000 4 400
i i
3 Pe
3 ve
2 Left Ear
é
2 © masking noise PAIR 4p SOM)
3 wo i. Tree baa FPN 33
z vane | welg
= ep wey 500 4 1000 4 2000 | 4000
10 we | Psa fy
120 ro + | Lee
Pe
‘125250800 —«1000 at “4000 0 He He.
: Frequeny
Ac TAD > 41.5 taiseaan® -AD = 19
alan
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