VA.gov Home | Veterans Affairs

RIGHT EAR LEFT EAR Acoustic immittance Normal Abnormal Normal Abnormal Ipsilateral Acoustic Reflexes Normal Abnormal Normal Abnormal Contralateral Acoustic Reflexes Normal Abnormal Normal Abnormal Unable to obtain/maintain seal ... ICD code: _____ Date of diagnosis: _____ ... Chest x-ray Date: _____ Results: _____ ... ................
................