wrs audiometry report templte

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WRS Audiometry Report Template

Word Document · DOCX

Here's what's included in the template:

Header

Department name, report title, and "CONFIDENTIAL" label in a blue banner across the top of every page.

Sections

Section	Contents
Patient Information	Name, DOB, Sex, MRN, Referral Source, Date, Audiologist, Clinic, Test Room
Relevant History	Chief complaint, duration, previous testing, HA use, noise exposure, tinnitus, vertigo
Test Conditions	Transducer type, masking, word list material (NU-6/W-22/HINT/BKB), presentation mode, response mode, testing condition, calibration date
Audiometric Summary	PTA (500-1k-2k Hz and 1k-2k-4k Hz), SRT, MCL, UCL - right/left unaided and aided
WRS Results Table	Presentation level, ear, word list, # correct/50, WRS%, condition (UA/HA/CI), notes - 6 rows
Rollover Index	WRS max, WRS at higher level, RI calculation, normal/abnormal cutoff (>=0.45)
Interpretation Reference	Color-coded guide: Normal (90-100%), Mild (78-88%), Moderate (66-76%), Poor (54-64%), Very Poor (<54%)
Clinical Interpretation	Right/left WRS labels + free-text comment lines
Recommendations	Checklist table: HA eval, CI eval, ENT referral, medical mgmt, aural rehab, follow-up, other - with priority column
Follow-up & Sign-off	Next appointment, audiologist name/license/signature, reviewer sign-off

Footer - Signature line, date, and page number on every page.

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