TX HHS Form 3105. Hearing Evaluation Report

The TX HHS Form 3105, Hearing Evaluation Report, is a comprehensive document that helps solve the problem of hearing disability evaluation. This form is typically filled out by participants in Comprehensive Rehabilitation Services (CRS) programs, such as those with hearing impairments or disabilities.

This report contains essential information about the participant's hearing condition, including details on when they first noticed their hearing problem, whether it occurred suddenly or slowly, and if there is a family history of hearing loss. The form also asks about the cause of the hearing loss, as well as any accompanying symptoms such as pain or drainage in the ears.

The TX HHS Form 3105 is designed to provide a thorough evaluation of an individual's hearing disability, allowing CRS professionals to better understand their needs and develop effective rehabilitation plans. Key features of this form include:

• Participant information, including name, Social Security number, telephone number, and birth date
• A comprehensive questionnaire about the participant's hearing condition and symptoms
• A section for recording the participant's reported disability and reason for referral