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  • Ear, Nose and Throat Examination: Name: Age: Date of Examination

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    Annisa Septyani
    132 views2 pages
    This document contains sections to record information from an ear, nose, and throat examination for a patient, including sections to note findings for each ear, the nose, tongue, tonsils, pharynx, results of an audiometry test, the patient's hearing status and overall ENT status, as well as spaces for notes on patient history, suggestions, and physician signatures.

    Original Description:

    ent form

    Original Title

    ENT FORM

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    This document contains sections to record information from an ear, nose, and throat examination for a patient, including sections to note findings for each ear, the nose, tongue, tonsils, pharynx, results of an audiometry test, the patient's hearing status and overall ENT status, as well as spaces for notes on patient history, suggestions, and physician signatures.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Download as doc, pdf, or txt
    132 views2 pages

    Ear, Nose and Throat Examination: Name: Age: Date of Examination

    Uploaded by

    Annisa Septyani
    This document contains sections to record information from an ear, nose, and throat examination for a patient, including sections to note findings for each ear, the nose, tongue, tonsils, pharynx, results of an audiometry test, the patient's hearing status and overall ENT status, as well as spaces for notes on patient history, suggestions, and physician signatures.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
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    EAR, NOSE AND THROAT EXAMINATION

    Name :
    Age :
    Date of Examination:

    ANAMNESIS :____________________________________________________

    ____________________________________________________

    EAR LEFT RIGHT

    Outer ear _____________ ______________

    Meatus _____________ ______________

    Tympanic membrane _____________ ______________

    Cone of light _____________ ______________

    Cerumen _____________ ______________

    OTHERS _____________ ______________

    NOSE
    SEPTUM
    ____________________________________________________

    CHONCAE
    ____________________________________________________

    OTHERS
    ____________________________________________________

    TONGUE _______________________________________________

    TONSIL _______________________________________________

    PHARYNX _______________________________________________

    AUDIOMETRY
    Hearing Level AD _____________ AS ______________

    HEARING STATUS:_______________________________________________

    ENT STATUS:____________________________________________________

    ____________________________________________________

    SUGGESTIONS:__________________________________________________

    Attending Physician:
    ________________________________

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