HEARING AID APPRENTICE VERIFICATION OF TRAINING AS AN APPRENTICE
Name of Colorado Hearing Aid Apprentice:
Name of Supervisor:
Hearing Aid Apprentice License Number:
Telephone Number: (
)
The above-named person, to be licensed as a hearing aid provider apprentice, will complete at least the first 6 months of training under direct supervision, including a minimum of 300 documented hours of onsite supervised training as a hearing aid apprentice in the following areas: •
Taking and reviewing case histories.
•
Otoscopy.
•
Hearing tests including air conduction and bone conduction with proper masking.
•
Speech testing including SRT, MCL, UCL, and discrimination with proper masking.
•
Interpretation of hearing tests and making medical referrals as necessary.
•
Taking of ear impressions including standard and completely in canal.
•
Fitting and post-fitting counseling including the delivery of the hearing aids, how to insert and remove the hearing aids, change batteries, and instructing the user and family as to expectations and performance.
•
Checking for proper fit and progress, and making needed adjustments.
•
Verification of hearing aid performance to determine if the hearing aid is correcting and conforming to the hearing loss as expected.
I understand that I must continue to monitor and sign all audiograms performed by the apprentice named herein, and approve all orders for hearing aids. I agree to notify the Office of Hearing Aid Provider Licensure within ten (10) business days if the apprentice leaves my supervision other than through obtaining full licensure as a hearing aid provider.
Supervisor Signature
1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800
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HEARING AID PROVIDER ... Name of Supervisor: Telephone Number: ( ) ... business days if the apprentice leaves my supervision other than through obtaining full ... Hearing Aid Provider - Verification of Completion of Training as an.pdf.
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