28 Pa. Code § 25.212
(a) Whenever a medical examination is performed under the act or Federal requirements, before fitting and selling a hearing aid the registrant shall ensure that a medical recommendation has been signed by the examining physician, within 180 days before the sale, on a form which includes the following statement or its equivalent:
I have medically evaluated the hearing ability of
(Patient’s Name)
and a hearing aid may be beneficial to this person.
(Signature of Physician)
(Date of Evaluation)
This section cited in 28 Pa. Code § 25.211 (relating to medical recommendations; waiver forms); and 28 Pa. Code § 25.214 (relating to recordkeeping).