NMCPHC TM-6260.51.99-3 (July 2020)
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2. All personnel enrolled in the HCP are required to obtain reference (baseline) and annual
medical surveillance hearing tests, which consist of pure tone, air conduction hearing threshold
measurements at test frequencies of 500, 1000, 2000, 3000, 4000, and 6000 Hz. Each ear is tested
separately and unaided. All audiometric assessments must be permanently retained in individual
health records. All required data fields can be found on a copy of the DOERHS-HC Demographic
Data Intake Form (sample provided on NMCPHC website).
a. Reference Audiograms are recorded on DD Form 2215. The reference hearing test will
not be administered unless the individual has been free from exposure to occupational and non-
occupational noise above 80 dBA for at least 14 hours. This requirement cannot be met by wearing
hearing protection devices. Five types of reference audiograms are used in the HCP:
Type 0 (Manually entered) Reference is manually entered into DOEHRS-HC when the
reference audiogram is not electronically available. It is entered to conduct comparison
with a periodic audiogram (DD Form 2216). This data will only be transcribed from a
DD Form 2215 from the employee’s medical record.
Type 1 (Baseline) Reference is administered prior to (within 30 days) employees
beginning initial work assignment in occupational noise exposure. All active duty
military personnel must receive a Type 1 reference audiogram at their first duty station.
Civilians who are enrolled in the HCP must receive a Type 1 reference audiogram upon
HCP enrollment. Diagnostic audiology evaluations are required when Type 1 reference
audiogram results are abnormal.
Type 2 (Baseline) Reference is administered after exposure to hazardous noise, such as
when the original reference audiogram was lost, or was never established. Diagnostic
audiology evaluations are required when Type 2 reference audiogram results are
abnormal.
Type 3 (Re-established) Reference is administered as the result of a follow-up program
and is used to re-establish the baseline due to a (negative or positive) PTS. Only an
Audiologist or HCPM can authorize the re-establishment of a baseline after a positive
(hearing gets worse) PTS. A certified HCT can re-establish reference audiograms when a
negative (DD2216 results are significantly better than the current reference) STS has
been verified and previous audiometric history has been reviewed.
Type 4 Reference is administered when there is a change in service component. A type 4
Reference is used for patients who are former active duty military and are now a civil
service employee or when a former civil service employee enters active duty service or
there is a break in service. In the case of civilians transferring between DoD service and
components (i.e., a worker employed by the Army transfers to Navy employment) the
baseline remains the same. Diagnostic audiology evaluations are required when Type 4
reference audiogram results are abnormal.
b. Medical Surveillance Monitoring Audiograms are recorded on DD Form 2216.
Monitoring hearing tests are used to detect incremental changes in hearing and identify potential
problems before the hearing loss begins to interfere with verbal communications, job performance,
or safety. Comparison is made between the most current monitoring audiogram with the most
current reference audiogram to determine whether significant changes in hearing have occurred. A
follow-up monitoring audiogram is required if results indicate a significant change in hearing in
order to validate the results. All follow-up audiograms must occur within 30 days for civilian
personnel or 90 days for military personnel to be considered valid. If follow-up testing is not