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Page 23

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Welch Allyn OAE Hearing Screener Directions for Use 705353 Rev E

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PEDIATRIC HEARING SCREENING RESULTS


Date of Exam:________________________

Patient’s Name:________________________

Date of Birth:________________________

This patient's hearing was screened using otoacoustic emissions. The

patient

referred on the hearing screening in one or both ears. The purpose of

this screening is to detect any hearing loss that could be detrimental to normal
speech and language development.

The hearing screening result does not mean that the patient definitely has

a hearing loss; however, it does mean that the patient needs further audiological
evaluation to either rule out or confirm a hearing loss. Further evaluation by an
audiologist experienced with pediatric assessment is recommended. Early
detection of hearing loss is critical for language development and/or school
success. If you have additional questions, do not hesitate to contact us.

An appointment has been made for further evaluation.

Date:_____________________________Time:_____________________
If you have any questions, do not hesitate to contact us.











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