Cochlear Implant Programming/Mapping Procedure Note

Date: [Date of service]

Time: [Time of service] (Include only if required by organization)

Location: [Clinic / Satellite / Inpatient]

Clinician: [Clinician name and credentials]

Patient: [Patient name or identifier]; Age: [Age in years or months]

Visit Type: [Initial Activation / Subsequent Reprogramming / Problem-Focused Troubleshooting / Upgrade Visit / Bilateral Coordination]

Ear(s) Addressed: [Left / Right / Bilateral]

Participants: [Patient alone / Caregiver or parent present / Interpreter present / Therapist present]

Behavioral Reliability (pediatric only): [Good / Fair / Poor]; [Brief rationale]; [Caregiver report substituted: Yes / No] (Include only for pediatric patients)

Reason for Visit

[Primary indication for today's visit] (Summarize in 1–3 sentences. Include onset, timeline, severity, and functional impact if problem-focused. A brief direct quote may be included if it clarifies the complaint. If reason is unclear, state that programming was performed per standard follow-up protocol.)

Interval History

[Changes since last mapping] (Address: perceived audibility of soft/environmental sounds; speech understanding in quiet vs noise, phone, and streaming; sound quality descriptors; comfort and loudness tolerance; typical daily wear time; data logging summary if available; priority listening environments and goals. Note symptoms such as skin irritation/breakdown at magnet site, dizziness/balance changes, head trauma, suspected infection, or tinnitus changes. Mention rehabilitation participation if relevant. If stable with no concerns, state: "No interval concerns reported; here for routine check.")

Device Information

Internal Implant: [Manufacturer]; [Model]; [Serial number or UDI]; [Implanted ear]; [Implantation date] (Note any surgical factors relevant to programming such as partial insertion or extra-cochlear electrodes. If serial number is unavailable, note where it should be located.)

• External Sound Processor ([Ear/Side]): [Manufacturer and model]; SN: [Serial number]; Coil/Cable: [Type]; Magnet Strength: [Value] (Note any change made today with rationale and skin check result); Battery: [Type and condition]; Program Slots in Use: [P1–P4 with intended environments]; Accessories: [Remote microphone / Telecoil / Streaming device / Other] (Repeat for each processor addressed today)

• Contralateral Technology: [Hearing aid or second CI details, model, serial, coupling, programs coordinated] (Include only if coordinated today)

Pre-Programming Checks

• Physical Site Check: [Skin and magnet site integrity findings] (Document redness, pressure marks, breakdown, pain/tenderness, infection concerns. If abnormal, describe severity, actions taken, and referral plan.)
• Equipment Function Check: [Microphones / Coil-cable integrity / Battery-charger / Processor controls / Connectivity] (Document what was assessed and outcomes. Include data logging summary if reviewed.)

Objective Measures

• Telemetry/Impedance: [Within normal limits / Abnormal]; [Notable exceptions and changes from prior visits]; [Open/short circuits and actions taken, e.g., electrode numbers disabled]
• Objective Responses: [ECAP / NRT / NRI / ART / ESRT]; [Electrodes tested]; [How results informed T/C/M level setting] (Include only if performed)
• Audiometric Measures: [Sound-field thresholds / Ling sound detection / Speech perception testing]; [Conditions]; [Presentation levels]; [Quiet vs noise with SNR]; [Aided configuration]; [Ear-specific / Bilateral] (Include only if performed)
• Measures Not Performed: [Reason] (e.g., time constraints, patient fatigue, poor reliability, not clinically indicated, scheduled separately)

Programming Procedure

Baseline at Arrival: [Current map/program name or number]; [Coding strategy]; [Stimulation mode]; [Stimulation rate]; [Active daily-use programs]

• T- and C/M-Level Adjustments: [Behavioral / Objective-supported / Estimated]; [Changes and rationale]
• Loudness Balancing: [Completed / Not completed]; [Method and outcome]
• Pitch Ranking: [Method and outcome] (Include only if performed)
• Electrode Changes: [Deactivated/reactivated electrode numbers and rationale] (e.g., abnormal impedance, non-auditory stimulation)
• Frequency Allocation Changes: [Changes made and rationale] (Include only if changed)
• Signal Processing Adjustments: [Sensitivity]; [Input dynamic range]; [Volume range]; [Microphone directionality]; [Noise reduction]; [Wind/impulse control]; [Telecoil mixing ratios]; [Program environment labels] (Document rationale for key changes)
• Real-World Check: [Patient response to conversational and loud levels]; [Audibility of soft speech]; [Adverse percepts: facial stimulation / pain / non-auditory sensations]; [Immediate functional check results]
• Programs Saved Today: [Number of programs]; [P1–P4 intended use]; [Map file save location and naming convention]; [Prior map retained as backup: Yes / No, program slot]

Verification/Validation

• Audibility/Sensitivity Check: [Sound-field thresholds and/or Ling sounds]; [Results and interpretation]
• Speech Perception: [Test name]; [Condition: quiet / noise with SNR]; [Presentation level]; [Configuration: ear-specific / bilateral]; [Interpretation] (Include only if performed)
• Patient-Reported Outcomes: [Perceived benefit/limitations after programming]
• Deferred Validation: [Reason for deferral]; [Scheduled plan] (Include only if validation deferred)

Assessment

(List problems in priority order. For each, include status and evidence source. If device failure is suspected, document objective findings prompting suspicion; do not state as confirmed without confirmatory testing.)

• [Problem 1]: [Status]; [Evidence source]
• [Problem 2]: [Status]; [Evidence source] (Add additional problems as needed)

Troubleshooting

(Include this entire section only if troubleshooting occurred; otherwise omit.)

• Presenting Device Problem: [Description]
• Stepwise Actions and Results: [Actions taken in sequence with outcome after each step]
• Parts Swapped/Replaced: [Component and serial number for each]; [Return/warranty status]
• Software Actions: [Reset / Firmware update / Re-initialization]; [Results]
• Manufacturer Contact: [Contacted: Yes / No]; [Case number]; [Guidance received]
• Loaner/RMA: [Details]; [Serial numbers]; [Return instructions]; [Patient education provided]
• Safety Check: [Post-troubleshooting functional check confirming stable operation]

Counseling and Education

• Program/Map Use Instructions: [Which program to use when; switching guidance]
• Device Care and Maintenance: [Cleaning, drying, battery and magnet care, storage]
• Wear-Time Goals: [Daily wear target and data logging goals]
• Listening Strategies and Expectations: [Realistic expectations; communication strategies; HAT/remote microphone recommendations]
• Red Flags Requiring Urgent Contact: [Pain, skin breakdown, infection signs, sudden performance drop, post–head trauma concerns]
• Understanding and Resources: [Patient/caregiver understanding: verbalized / teach-back]; [Handouts/resources provided]; [Barriers and mitigation]
• Referrals: [Surgeon / SLP-AVT / Educational audiology / Vestibular evaluation / Other]
• Coverage/Warranty Counseling: [Summary of discussion] (Include only if addressed)

Plan

• Follow-Up: [Specific interval]; [Date-anchored timing if needed]; [Planned assessments] (e.g., impedance check, aided thresholds, speech testing)
• Contingency Triggers for Sooner Visit: [Intermittency / Discomfort / Skin issues / Perceived decline / Other]
• Home Program/Tasks: [Rehab app or exercises; streaming practice; wear-time targets]
• Pediatric Coordination: [Caregiver action items]; [School/therapy coordination and communication plan] (Include only for pediatric patients)

(Include only information explicitly observed, measured, or stated during this encounter. Remove optional sections and bullets that were not applicable today.)