Forms

Case History Forms

•  Case History Form

• Musician’s Case History Form

Hearing Aid Selection

• Characteristics of Amplification Tool (COAT)

• HAT Needs Checklist

• Hearing Aid Selection Profile (HASP)

Medical Appointments

A Communication Access Plan (CAP) is a one page form to be presented to your health care team. Request that your CAP be added to your electronic medical record (EMR). Your CAP should include your personal information, your hearing status, hearing aid information, and any assistive devices you might need for your medical appointment or hospitalization.