The hearing aid services provider shall maintain supporting records, including:

1. (a) An audiogram;
2. (b) Audiological and medical data, documenting the required criteria, as established in accordance with He-W 567, to support the request for the hearing aid(s) or pocket talker;

3. (c) For those recipients 21 years of age or over requesting binaural hearing aids in accordance with He-W 567.05(c)(2)b.1.(ii):

   1. (1) A statement from the recipient’s employer verifying the recipient’s employment status, and including the employer's audiometric requirements for the particular position in which the recipient is employed;
   2. (2) A statement from the audiologist that the recipient cannot meet the employer’s audiometric requirements in (1) without the use of binaural hearing aids; and
   3. (3) An audiogram which supports the audiologist's statement in (2) above; and
4. (d) A letter from the recipient’s school verifying attendance or documentation confirming the recipient is receiving vocational training, if applicable.

Source. (See Revision Note at chapter heading He-W 500); ss by #6157, eff 12-29-95, EXPIRED: 12-29-03 New. #9480, eff 5-23-09; ss by #9739, eff 6-25-10; renumbered by #10342 (from He-W 567.07); ss by #12538, eff 5-25-18