Hearing Aid Follow-Up/Adjustment Note

Date of Service: [Date of service]

Provider: [Provider name and credentials]

Patient: [Patient name or identifier]

Encounter Type: [in-person / teleaudiology] (If remote, briefly note any examination or verification limitations.)

Devices:

• Right Ear: [Manufacturer], [Model], SN: [Serial number], [Coupling type] (Include accessories only if addressed this visit. If serial number unavailable, state reason.)
• Left Ear: [Manufacturer], [Model], SN: [Serial number], [Coupling type] (Include accessories only if addressed this visit. If serial number unavailable, state reason.)

(Omit ear line if monaural fit; adapt labeling for bimodal configurations.)

Subjective

Chief Concern: [Chief concern in patient's words] (Document verbatim or close paraphrase.)

Interval History: [Time since fitting or last adjustment] [Relevant changes: new ear symptoms, health changes, environmental demands] (Include only changes explicitly mentioned.)

Use/Wear: [Daily wear time in hours/day] [Source: patient report / data logging]

Patient-Reported Outcomes: [Perceived benefit, limitations, and specific complaints regarding sound quality, speech understanding, comfort, feedback, connectivity, or handling] (Do not infer satisfaction; document only what patient reports.)

Objective

Otoscopy: [Findings by ear] (If not performed, state reason.)

Device Inspection: [Visual check findings] [Listening check: clear / distorted / weak / no output by ear] [Battery/charging status if relevant] (Note any physical findings explaining the complaint.)

Verification Measures: [Method] [Key results] [Brief interpretation] (Omit this field entirely if no verification was performed.)

Interventions

Maintenance: [Action] - [Ear] - [Outcome] (List each action: cleaning, wax guard change, dome/receiver replacement, tubing change, repair initiation.)

Programming Changes:

• Problem: [Complaint prompting change]
• Action: [Adjustments made: gain regions, compression, features, programs, streaming settings]
• Response: [Immediate in-clinic patient feedback]

(Repeat Problem-Action-Response block for each issue addressed. If no programming changes, state: "No programming changes made today.")

Assessment

[Device function status after interventions] [Physical fit adequacy] [Audibility assessment based on today's findings] [Remaining limitations or uncertainties] (Note if findings suggest need for medical referral.)

Plan

Counseling Provided: [Topics actually covered this visit] (If deferred, state reason.)

Follow-up: [Timing] - [Purpose]

Pending Items: [Orders, repairs, or parts with expected timelines] (Omit if none.)

Return Precautions: [Ear pain, drainage, sudden hearing change, skin irritation]

Referrals: [Referral details] (Omit if none.)