TX HHS Form 3105. Hearing Evaluation Report

The TX HHS Form 3105, Hearing Evaluation Report, is a comprehensive tool used to assess hearing disabilities and track participant information. This form helps solve the problem of identifying and documenting individual hearing impairments, allowing for targeted rehabilitation services.

The report requires key information about participants, including their name, social security number, telephone number, and birth date. The Participant Questionnaire section is crucial in understanding the nature of the hearing disability, such as when it was first noticed, whether it occurred suddenly or slowly, and if there is a family history of hearing loss.

This report should be used by Comprehensive Rehabilitation Services (CRS) to document participant information and track progress. The form's sections on Hearing Disability Information provide valuable insights into the causes and effects of hearing loss, enabling CRS to develop effective treatment plans. By completing this report, CRS can ensure that participants receive the necessary support and rehabilitation services.