Management Branch Office of Licensing

HEARING AID PROVIDER VERIFICATION OF COMPLETION 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, who is licensed as a hearing aid provider apprentice, has completed at least the first 6 months of training under direct supervision, including a minimum of 300 documented hours of on-site 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.

This individual is now competent to continue performing the above activities under my direct supervision and/or pass the ILE in order to apply for a license as a hearing aid provider. 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

License Number

F 303.894.7693 www.dora.colorado.gov/professions

Date

Hearing Aid Provider - Verification of Completion of Training as an ...

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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