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Get Ms Gulfport School District Hearing/vision Screening Report 2015-2024

SMENT A. HEARING SCREENING Instrument: st 1 Screening L Ear 1000 Hz / 25 dB R Ear L Ear 2000 Hz / 25 dB R Ear L Ear 4000 Hz / 25 dB R Ear Optional: L Ear R Ear PASS Hearing FAIL EXAMINER DATE B. VISION SCREENING Instrument: nd 2 Screening L Ear R Ear L Ear R Ear L Ear R Ear L Ear R Ear PASS FAIL st 1 Screening YES Screened wearing glasses? NO PASS Near Vision (Both Eyes) FAIL / Far Vision Left Eye Right Eye / Both Eyes / PASS FAIL nd 2 Screening YES NO PASS FAIL / / / PASS FAIL EXAMINER D.

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