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Ears Consider denominators indicated here as normal. Record as numerators the greatest distance heard. Pre-addressed Confidential-Medical envelope provided. rendered. U.S. Office of Personnel Management Section 3301 of Title 5 United States Code Title 5 CFR 339 For Local Reproduction Only Page 1 of 8 Optional Form 178 July 2009 Formerly SF 78 Previous editions not useable Part A. Audiometer in dB if given for Right Ear Ordinary conversation Right Ear 20 ft. Left Ear 4. Other Findings Describe...

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