Patients admitted to facilities shall be screened for hearing impairment. Gross Testing of Hearing Sensitivity. At each facility, an examination shall be performed for gross testing of hearing sensitivity on all newly admitted patients within 24 hours of admission. This examination shall be performed: By a physician or a qualified allied health professional; and According to the following protocol: Testing shall occur consistently at a fixed distance from the speaker at all times; In order to prevent speech reading which could be interpreted as a false positive, the speaker's face may not be in view by the patient while testing is in process; and Non-English speaking patients shall be tested in the language the patient is known to speak or is believed to comprehend. Testing performed in conformance with §B(1) of this regulation shall be repeated within 15 days after admission on all patients not already tested with a pure tone screening audiometer. Each test performed in compliance with this regulation shall be documented in the patient's chart. Once a hearing impairment is suspected: Rinne and Weber testing shall be performed; and Referral shall be made for audiometric screening. Audiometric Screening. Patients with Suspected Hearing Impairment. Pure tone audiometric screening shall occur within 3 working days from the period specified in §B(1), of this regulation, for any patient who: Is suspected of having a hearing impairment on the basis of any of the above tests; Was unresponsive because of a possible hearing impairment; or Responded in a manner that may be construed as a mental disorder, but may be confused with a possible hearing impairment. Patients suspected of having a hearing impairment on the basis of the latest pure tone audiometric screening shall be referred promptly but in not more than 5 working days to an audiologist or an otolaryngologist. Referral shall be documented in the patient's chart. Upon recommendation by either the otolaryngologist or audiologist, further evaluation by a speech-language pathologist shall be conducted. If the audiometric screening in this section is used as the initial screening test, that audiometric screening shall be sufficient testing on admission unless otherwise ordered. Patients Not Identified as Hearing Impaired. As soon as possible, but within 90 days after admission, each patient who has not already been screened with an audiometer shall be so evaluated. Each patient's annual physical examination shall include audiometric screening. The screening results shall be documented in the patient's chart. Procedures for Audiometric Screening. The audiometric screening shall be performed in accordance with the standards outlined in Regulations .04 and .05 of this chapter. The audiometric screening shall be administered by either: A physician trained to screen hearing according to the protocol established in this chapter; An audiologist; or Appropriately and periodically trained allied health care staff, under the supervision and monitoring of an audiologist. An audiologist shall determine the facility's training protocol and frequency of training for allied health care staff. At a minimum, training shall occur at least once a year. Patients Exempted from Audiometric Screening. If the patient has a history of hearing impairment as defined in Regulation .02B(8) of this chapter and documented by an audiologist or physician, the screening procedure identified in §B and C of this regulation is not required within the first year after admission. Treatment recommendations related to the patient's hearing impairment made by either an audiologist, otolaryngologist, or speech pathologist, shall be incorporated in the patient's Individual Treatment Plan. Provision and Maintenance of Hearing Aids. The patient and appropriate staff on each shift shall receive, in accordance with a plan developed by an audiologist, instructions on the care, use, and inspection of the hearing aid by staff referenced in §C(4)(b)(i) and (ii) of this regulation or the hearing aid vendor. Designated staff, as identified in the Individual Treatment Plan, shall be responsible for ensuring daily monitoring of hearing aids, and implementing timely repair and immediate replacement of batteries. Identification of the need for replacement as well as the replacement of the patient's hearing aid shall be documented in the patient's record. Denial of hearing aid replacement by the treatment team or the patient's refusal to accept a hearing aid shall be documented and be reevaluated at a minimum of every 3 months. The facility shall provide a hearing aid to the patient when an otolaryngologist or audiologist determines that a patient would benefit from amplification and related accessories. Payments for aids shall follow the Administration's policy on payment for medical devices.