Texas Medicaid uses this one-page report for the physician's ear examination and medical clearance before a client is evaluated and fitted for a hearing aid. The physician records ear findings and cerumen removal, whether more otolaryngology care is needed, any medical contraindication by ear, and whether the client is a hearing aid evaluation candidate. The patient takes the signed original.
A physician or delegate completes the examination and physician sections and signs; stamped signatures are not accepted. If more otolaryngological evaluation is needed, the patient is referred for a consultation and completion of this form.
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Physician's Examination Report
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It documents the physician's ear examination and medical clearance for a Texas Medicaid client who needs a hearing aid. The physician records whether the ears are within normal limits, any abnormalities, contraindications by ear, and whether the client is a candidate for a hearing aid evaluation.
The form states that to be reimbursed for the examination, the physician must submit the completed form along with a claim for physician's services to TMHP. Separately, the patient receives the signed original and one copy to take forward for the hearing aid evaluation and fitting.