I have medically evaluated the hearing ability of
_________________________
(Patient's Name)
and a hearing aid may be beneficial to this person.
_________________________
(Signature of Physician)
_________________________
(Date of Evaluation)
28 Pa. Code § 25.212
This section cited in 28 Pa. Code § 25.211 (relating to medical recommendations; waiver forms); and 28 Pa. Code § 25.214 (relating to recordkeeping).