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Colorado Hearing Instrument Specialist — Requirements & Free Practice

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Hearing Aid Provider

Colorado licenses the requested hearing instrument specialist profession as a Hearing Aid Provider. Inactive status and reinstatement/reactivation remain states or routes of this same license. The formerly issued trainee and associate licenses are discontinued under Rule 1.3(A)(1) and (C); no current issuance, renewal, or reinstatement route is created for them.

Licensing authority: Colorado Department of Regulatory Agencies, Division of Professions and Occupations, Office of Hearing Aid Provider Licensure · Application information

Licensure by endorsement through substantially equivalent education and certification
No examination is required for this applicant pathway.
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Director equivalency
The Director must find the experience or credentials substantially equivalent to original Colorado qualifications.
Education or training
Provide a degree concentrated in hearing aid fitting and dispensing or supervised training; the Director may substitute two years of active practice in good standing during the preceding five years for this education/training element.
Existing authority
Hold a current credential in good standing in another state, U.S. territory, another country, through the federal government, or a qualifying military occupational specialty, under C.R.S. 12-20-202(3).
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Foreign country rule statement
C.R.S. 12-20-202(3)(b)(I), as amended effective August 12, 2026, includes another country. The lower-ranked 2022 Rule 1.2(A)(1) states: 1. Possess an active license in good standing to practice as a hearing aid provider in another state or United States territory, through the federal government, or a military occupational specialty, as defined in section 24-4-201, C.R.S.; and
Implementation one year statement
The guide's later endorsement page states: In order to be licensed by endorsement, the applicant must hold an active Hearing Aid Provider license in another state or jurisdiction for at least one year.
National certification
Provide certification in hearing aid fitting and dispensing through an accredited national certifying agency such as NBC-HIS. Certification is an applicant credential, not an inferred NCE passing-score requirement.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.

Official no-examination sources

Effective from 2026-09-22.

Licensure by endorsement with one year of comparable licensure
No examination is required for this applicant pathway.
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Duration and scope
Hold a current and valid credential for at least one year in a jurisdiction whose scope is substantially similar, and have no act constituting grounds for discipline.
Existing authority
Hold a current credential in good standing in another state, U.S. territory, another country, through the federal government, or a qualifying military occupational specialty, under C.R.S. 12-20-202(3).
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Foreign country rule statement
C.R.S. 12-20-202(3)(b)(I), as amended effective August 12, 2026, includes another country. The lower-ranked 2022 Rule 1.2(A)(1) states: 1. Possess an active license in good standing to practice as a hearing aid provider in another state or United States territory, through the federal government, or a military occupational specialty, as defined in section 24-4-201, C.R.S.; and
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.

Official no-examination sources

Effective from 2026-09-22.

Licensure by endorsement with practice substituted for examination or certification
No examination is required for this applicant pathway.
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Education or training
Provide a degree concentrated in hearing aid fitting and dispensing or supervised training.
Existing authority
Hold a current credential in good standing in another state, U.S. territory, another country, through the federal government, or a qualifying military occupational specialty, under C.R.S. 12-20-202(3).
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Foreign country rule statement
C.R.S. 12-20-202(3)(b)(I), as amended effective August 12, 2026, includes another country. The lower-ranked 2022 Rule 1.2(A)(1) states: 1. Possess an active license in good standing to practice as a hearing aid provider in another state or United States territory, through the federal government, or a military occupational specialty, as defined in section 24-4-201, C.R.S.; and
Military practice credit
Military service counts toward active practice when it generally conforms to the Colorado hearing aid provider scope.
Practice substitution
The Director may substitute two years of active practice in good standing in the last five years for Rule 1.2(B)(2), the examination-or-certification element. This route depends on approval of that substitution.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.

Official no-examination sources

Effective from 2026-09-22.

Renewal while remaining inactive
No examination is required for this applicant pathway.
Practice prohibition
Inactive status is noted on the license and practice while inactive may be grounds for revocation.
Status
Remain inactive and comply with the normal registration/renewal requirements and fees.

Official no-examination sources

Effective from 2026-09-22.

Transfer an existing license to inactive status
No examination is required for this applicant pathway.
Existing license
Hold a Hearing Aid Provider license and give written notice to transfer to inactive status.
Practice prohibition
Do not practice while inactive; maintain normal registration requirements. Educational requirements are excused during inactivity under C.R.S. 12-20-203, while Rule 1.4 requires CE proof on reactivation.

Official no-examination sources

Effective from 2026-09-22.

Licensure by endorsement for relocated military family members
No examination is required for this applicant pathway.
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Existing credential
Submit proof under penalty of perjury of an active credential in good standing from another state or U.S. territory.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Qualifying family relationship
Be a relocated military spouse, gold star military spouse, military dependent, or spouse/dependent of another qualified servicemember within C.R.S. 12-20-202(3)(f).
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.
Statutory entitlement
Subject to the statutory compact/reciprocity and good-standing exceptions, the license is valid for six years, renewable, and the application fee is waived.

Official no-examination sources

Effective from 2026-09-22.

Original licensure using military training credit
International Licensing Examination for Hearing Healthcare Professionals
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Entry level examination
For an applicant using military training instead of the associate degree under Rule 1.10(E), passing the examination specified in Rule 1.1(A)(2) remains required.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Military credit
Submit timely and complete records of substantially equivalent military education, training or experience. The Director assesses equivalency case by case and specifies any remaining training.
Other approved entry level examination
Rule 1.1(A)(2) also accepts another appropriate entry-level examination approved by the Director; the official text does not identify any additional examination. This open remainder is an applicant condition.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.
Original licensure
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Entry level training
For the ILE or another Director-approved entry-level examination, complete at least six months of training with a licensed audiologist or hearing aid provider, or hold an accredited/Director-approved associate degree in hearing aid fitting and dispensing. Training under Rule 1.3 includes at least 300 documented hours of on-site supervision. The NCE competency alternative in C.R.S. 12-230-201(3)(a) does not carry the entry-level alternative's additional training/degree condition.
Exam timing
The initial application states that NBC-HIS examination evidence must be supplied before application; ILE approval is provided after submitting the application. A currently offered examination remains referenced regardless of when it was passed.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Foreign training
The DPO guide directs foreign-trained applicants to document equivalency of education and training and identifies a foreign credential evaluation if applicable; the guide says applicants will likely need an evaluation recognized by DORA.
Other approved entry level examination
Rule 1.1(A)(2) also accepts another appropriate entry-level examination approved by the Director; the official text does not identify any additional examination. This open remainder is an applicant condition.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.
Reactivation after more than five years inactive
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Application and ce
Submit the reinstatement or reactivation application and fee and attest to at least eight CE hours for each year expired or inactive under Rule 1.4(A)-(B).
Conflicting implementation
The lower-ranked DPO Colorado DPO Hearing Aid Provider Reactivation Application and Checklist also offers non-exam continued-competency alternatives for five years or more. The route follows Rule 1.4(D); the applicant sees the implementing statement: If your license became inactive 5 years ago or more, you must provide ONE of the following: ● Submit an active license/certification/registration verification from another jurisdiction in good standing where you have practice for 2 of the last 5 years and attest to that practice. ● Submit proof of retaking and passing the National Competency Exam (NCE) offered by the National Board for Certification in Hearing Instrument Sciences (HBC-HS) in the last 2 years. ● Provide documentation that you maintained an Active Board Certification with HBC-HS. ● Plan to practice under supervised practice for a specific time period, which will be established after submitting the reactivation application by the Director. ● Submit an approval letter and supporting documents showing completion of a director’s pre-approved competency to practice by another means.
Elapsed period
More than five years inactive as of receipt of the application.
Entry level training
For the ILE or another Director-approved entry-level examination, complete at least six months of training with a licensed audiologist or hearing aid provider, or hold an accredited/Director-approved associate degree in hearing aid fitting and dispensing. Training under Rule 1.3 includes at least 300 documented hours of on-site supervision. The NCE competency alternative in C.R.S. 12-230-201(3)(a) does not carry the entry-level alternative's additional training/degree condition.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Original qualifications
Rule 1.4(D) requires the qualifications of Rule 1.1: NCE or ILE/another approved entry-level examination with the applicable training or degree and financial assurance.
Other approved entry level examination
Rule 1.1(A)(2) also accepts another appropriate entry-level examination approved by the Director; the official text does not identify any additional examination. This open remainder is an applicant condition.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.
Reactivation after more than two and no more than five years inactive
National Competency Exam (NBC-HIS)
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Application and ce
Submit the reinstatement or reactivation application and fee and attest to at least eight CE hours for each year expired or inactive under Rule 1.4(A)-(B).
Competency alternatives
The Director accepts competency proof through another-state licensure with two years of practice in the preceding five years, 30 approved CE hours within two years, at least six months of supervised practice, NCE retake, maintained NBC-HIS certification, or another Director-approved means. These alternatives may excuse the individual applicant from the examination.
Elapsed period
More than two and no more than five years inactive as of receipt of the application.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Nce recency
If using the examination option, retake and pass NCE within the two years immediately preceding the application.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.
Reactivation after no more than two years inactive
No examination is required for this applicant pathway.
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Application and ce
Submit the reinstatement or reactivation application and fee and attest to at least eight CE hours for each year expired or inactive under Rule 1.4(A)-(B).
Elapsed period
The license has been inactive for no more than two years as of receipt of the application; the additional competency-to-practice provisions in Rule 1.4(C) apply only after more than two years.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement after more than five years expired
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Application and ce
Submit the reinstatement or reactivation application and fee and attest to at least eight CE hours for each year expired or inactive under Rule 1.4(A)-(B).
Conflicting implementation
The lower-ranked DPO Colorado DPO Hearing Aid Provider Reinstatement Application Checklist also offers non-exam continued-competency alternatives for five years or more. The route follows Rule 1.4(D); the applicant sees the implementing statement: If your license expired 5 years ago or more, you must provide ONE of the following: ● Submit an active license/certification/registration verification from another jurisdiction in good standing where you have practice for 2 of the last 5 years and attest to that practice. ● Submit proof of retaking and passing the National Competency Exam (NCE) offered by the National Board for Certification in Hearing Instrument Sciences (HBC-HS) in the last 2 years. ● Provide documentation that you maintained an Active Board Certification with HBC-HS. ● Plan to practice under supervised practice for a specific time period, which will be established after submitting the reinstatement application by the Director. ● Submit an approval letter and supporting documents showing completion of a director’s pre-approved competency to practice by another means.
Elapsed period
More than five years expired as of receipt of the application.
Entry level training
For the ILE or another Director-approved entry-level examination, complete at least six months of training with a licensed audiologist or hearing aid provider, or hold an accredited/Director-approved associate degree in hearing aid fitting and dispensing. Training under Rule 1.3 includes at least 300 documented hours of on-site supervision. The NCE competency alternative in C.R.S. 12-230-201(3)(a) does not carry the entry-level alternative's additional training/degree condition.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Original qualifications
Rule 1.4(D) requires the qualifications of Rule 1.1: NCE or ILE/another approved entry-level examination with the applicable training or degree and financial assurance.
Other approved entry level examination
Rule 1.1(A)(2) also accepts another appropriate entry-level examination approved by the Director; the official text does not identify any additional examination. This open remainder is an applicant condition.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.
Reinstatement after more than two and no more than five years expired
National Competency Exam (NBC-HIS)
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Application and ce
Submit the reinstatement or reactivation application and fee and attest to at least eight CE hours for each year expired or inactive under Rule 1.4(A)-(B).
Competency alternatives
The Director accepts competency proof through another-state licensure with two years of practice in the preceding five years, 30 approved CE hours within two years, at least six months of supervised practice, NCE retake, maintained NBC-HIS certification, or another Director-approved means. These alternatives may excuse the individual applicant from the examination.
Elapsed period
More than two and no more than five years expired as of receipt of the application.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Nce recency
If using the examination option, retake and pass NCE within the two years immediately preceding the application.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.
Reinstatement after no more than two years expired
No examination is required for this applicant pathway.
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Application and ce
Submit the reinstatement or reactivation application and fee and attest to at least eight CE hours for each year expired or inactive under Rule 1.4(A)-(B).
Elapsed period
The license has been expired for no more than two years as of receipt of the application; the additional competency-to-practice provisions in Rule 1.4(C) apply only after more than two years.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.

Official no-examination sources

Effective from 2026-09-22.

Renewal of active license
No examination is required for this applicant pathway.
Application
Submit the applicable application and fee and provide required name-change, licensing-history, conduct and disciplinary disclosures and supporting documents.
Continuing education
Complete at least eight CE hours during each year of the two-year license period in subjects related to the scope of practice; retain CE documentation four years.
Financial assurance
Post a $10,000 surety bond, maintain a $1 million professional liability policy, or obtain Director approval of substantially equivalent financial assurance; maintain it during practice.
License expiration
Provider licenses expire March 31 of even-numbered years; renew on the DPO schedule, with the statutory 60-day grace period and applicable delinquency fee.
Military exemption
C.R.S. 12-20-302 exempts qualifying federally activated military personnel from fees and CE/competency requirements for the covered renewal cycle; request program approval of other CE exceptions.
Profile
Provide the Healthcare Professions Profile information required by C.R.S. 12-30-102.
Records
Develop the written customer-record maintenance plan required by C.R.S. 12-230-205 and Rule 1.5.

Official no-examination sources

Effective from 2026-09-22.

International Licensing Examination for Hearing Healthcare Professionals

Provider
International Hearing Society (IHS); scheduled and paid through the TestWise system at testing centers
Format
Practice-based computer-delivered multiple-choice examination; most questions present a scenario; a few questions require selecting two (or three) correct answers to earn one point; dichotomous right/wrong scoring
Exam questions
105 multiple-choice questions: 80 scored and 25 unscored pilot questions
Time limit
120 minutes (two hours)
Passing score
Pass/Fail on the overall raw score against the IHS-recommended passing score; the licensing agency makes the final decision
Exam fee
$260.00 (USD) per examination appointment, including re-takes, plus applicable taxes
Examination outline
  • Domain 1. Conduct Patient/Client Assessment (21%) (21%)
    • Objective 1.1 Apply infection control protocols (5%). Includes but is not limited to choosing appropriate infection control processes for tools and equipment; observing universal precautions for infection control; distinguishing between single- and multiple-use items; differentiating among sanitization, disinfection and sterilization processes; and identifying personal protective equipment.
    • Objective 1.2 Apply otoscopic inspection protocols (5%). Includes but is not limited to observing safety protocols during otoscopy; identifying anatomical structures; identifying abnormalities through otoscopic inspection; and recognizing the presence of referral criteria. This objective helps provide evidence of the candidate’s ability to perform otoscopy.
    • Objective 1.3 Utilize audiometric testing protocols (11%). Includes but is not limited to performing air and bone conduction threshold and suprathreshold testing; performing speech audiometry; performing effective masking; and applying principles to include interpreting results of tympanometry/immittance audiometry. This objective helps provide evidence of the candidate’s ability to perform audiometric testing and application of tympanometry.
  • Domain 2. Interpret and Apply Assessment Results (22%) (22%)
    • Objective 2.1 Interpret and explain audiometric results (11%). Includes but is not limited to demonstrating an understanding of referral criteria; interpreting pure tone and speech testing results; identifying the need for additional testing; identifying the degree and configuration of hearing loss; and identifying the type of hearing loss.
    • Objective 2.2 Determine candidacy for amplification (11%). Includes but is not limited to interpreting the case history and outlining contraindications to hearing instrument use.
  • Domain 3. Select Hearing Devices (18%) (18%)
    • Objective 3.1 Select style and type of hearing instruments (9%). Includes but is not limited to establishing fitting goals and selecting specific hearing instruments based on test results, case history, and individual patient/client preferences and lifestyle; selecting electroacoustic and physical properties; and evaluating the need for accessory devices.
    • Objective 3.2 Select earmold or other acoustic coupler (9%). Includes but is not limited to assessing physical properties of the outer ear, taking ear impressions, critiquing ear impressions, and selecting coupler based on patient/client needs.
  • Domain 4. Fit and Dispense Hearing Devices (20%) (20%)
    • Objective 4.1 Utilize protocols to fit hearing instruments and other devices (10%). Includes but is not limited to confirming physical and acoustic integrity of hearing devices; programming and adjusting hearing devices; verifying physical fit and acoustic comfort; orienting patient/client to hearing instruments; and orienting patient/client to assistive devices. This objective helps provide evidence of the candidate’s ability to program and dispense hearing instruments and other devices.
    • Objective 4.2 Verify fitting (5%). Includes but is not limited to selecting verification method based on patient/client; assessing physical and acoustic integrity of hearing devices; interpreting and explaining verification results; and modifying physical and acoustic parameters of device. This objective helps provide evidence of the candidate’s ability to perform fitting verification (e.g., speech mapping, REM).
    • Objective 4.3 Validate fitting (5%). Includes but is not limited to selecting validation method based on patient/client; interpreting and explaining validation results; and modifying physical and acoustic parameters of device. This objective helps provide evidence of the candidate’s ability to perform fitting validation (e.g., questionnaire, self-assessment).
  • Domain 5. Provide Continuing Care (19%) (19%)
    • Objective 5.1 Implement aural rehabilitation and counseling (8%). Includes but is not limited to demonstrating an understanding of the psychology of the hearing impaired; defining and managing patient/client expectations for improved communication; defining and managing family/caregiver expectations for improved communication; and identifying communication strategies.
    • Objective 5.2 Apply instrument maintenance and troubleshooting protocols (9%). Includes but is not limited to employing hearing instrument cleaning procedures; performing listening checks on hearing instruments; troubleshooting acoustic properties of hearing instruments; and adjusting based upon changes in patient/client hearing loss and/or listening needs. This objective helps provide evidence of the candidate’s ability to maintain and troubleshoot instrument performance.
    • Objective 5.3 Interpret electroacoustic analysis results (2%). Includes but is not limited to identifying need for electroacoustic analysis and comparing electroacoustic analysis of patient’s/client’s hearing instruments to fitting specifications.
Examination sources

National Competency Exam (NBC-HIS)

Provider
National Board for Certification in Hearing Instrument Sciences (NBC-HIS); scheduled through Kryterion Webassessor at testing centers
Format
Computer-based multiple-choice board certification examination for holders of a current dispensing license or certificate of registration (where applicable); items from the five competency areas are randomly distributed and scored as a single exam, each item correct or incorrect with no partial credit
Exam questions
100 scored multiple-choice items, sometimes with as many as 30 additional non-scored beta items
Time limit
105 minutes for the 100-question exam; adjusted automatically when beta questions are added
Passing score
Criterion-referenced passing standard set by a modified Angoff methodology; pass or fail reported for the entire exam
Exam fee
$225 (USD) for United States & Canada or $250 (USD) for International, per exam sitting
Examination outline
  • DOMAIN 1: Assess patient presenting problem and needs (25%) (25%)
    • 1) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes a family history of hearing loss.
    • 2) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes childhood hearing-related illnesses.
    • 3) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes hearing loss duration, dizziness, loss of balance, and/or tinnitus.
    • 4) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes hearing loss duration, trauma and/or discomfort.
    • 5) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes past and/or current health conditions and/or medication/drug history.
    • 6) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes occupations or recreational activities that include exposure to noise and acoustic trauma.
    • 7) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario including history of ear surgeries, diseases and treatments.
    • 8) Identify the potential impact on patient's lifestyle (e.g., family, work, social activities) given a patient scenario of hearing loss type (e.g., SNHL).
    • 9) Identify which patient scenario would most likely require a medical referral based on given symptoms (e.g., impacted cerumen, asymmetric hearing loss, sudden onset hearing loss).
    • 10) Identify the most appropriate type of preventative hearing protection given a patient scenario involving noise exposure.
    • 11) Differentiate between scenarios that indicate a hearing loss vs. lack of understanding (e.g., cognitive decline, retrocochlear).
  • DOMAIN 2: Test and analyze patient hearing (25%) (25%)
    • 1) Identify irregularities/obstructions during an otoscopic examination.
    • 2) Identify when the patient would benefit from cerumen management, removal, and/or precautions in cerumen management.
    • 3) Identify the degree and type of hearing loss based on the pure-tone air and bone-conduction given audiometric results (e.g., mixed hearing loss, SNHL).
    • 4) Identify condition(s) that would cause the tympanogram and/or reflex configuration given tympanogram and/or reflex results.
    • 5) Identify potential methods for managing tinnitus.
    • 6) Identify when to conduct speech awareness vs. speech reception threshold test.
    • 7) Identify how speech discrimination test results would impact the patient's outcome, most appropriate treatment option, or additional testing.
    • 8) Determine whether this was over masked, under masked, effectively masked, masking was not necessary, or a masking anomaly (e.g., interaural attenuation) given audiometric test results showing air- and/or bone-conduction testing and masking levels.
    • 9) Identify the potential impact on fitting given a patient scenario involving Speech Reception Threshold (SRT), Most Comfortable Listening Level (MCL), and/or Uncomfortable Loudness Level (UCL) (e.g., recruitment).
    • 10) Interpret Speech in Noise (SIN) results and impact on treatment plan.
    • 11) Identify signs of irregular test results and/or the potential causes of irregular test results (e.g., malingering, user error, equipment failure).
    • 12) Identify the results that indicate recommendation for medical referral given otological or hearing test results (e.g., binaural interference, PTA vs. SRT discrepancy, air-bone gap).
    • 13) Identify when a client is a possible candidate for a surgical solution (e.g., cochlear implant, Bone-anchored Hearing Aid (BAHA), PE tubes).
    • 14) Select the best audiometric transducer given physical considerations of the patient (e.g., supra-aural vs. insert earphones).
  • DOMAIN 3: Prescribe and analyze hearing instruments (25%) (25%)
    • 1) Identify the appropriate hearing instrument (e.g., style, configuration, matrix, rechargeable vs. battery) given a patient scenario that includes physical and/or cognitive limitations.
    • 2) Identify which telephone use options are most appropriate given a patient scenario including physical/cognitive limitations or knowledge of technology.
    • 3) Identify which Assistive Listening Devices (ALDs) are most appropriate given a patient scenario that includes lifestyle, physical/cognitive limitations and/or knowledge of technology.
    • 4) Identify the contraindications for Invisible-in-Canal (IIC) hearing instruments given a patient's ear canal, size, hearing loss and lifestyle (i.e., extended or daily wear use).
    • 5) Identify the most appropriate modification to the procedures and/or materials during an ear impression (e.g., gun vs. syringe, otoblock size/type, mastoid and/or piercings, unusual/missing pinna).
    • 6) Identify the most appropriate tube, tube length, dome size, earmold, or receiver power for over-the-ear (OTE) hearing instruments.
    • 7) Identify the most appropriate wire, wire length, dome size, earmold, or receiver power for receiver-in-canal (RIC) hearing instruments.
    • 8) Identify the most appropriate tube, tube length, dome size, earmold, or receiver power for behind-the-ear (BTE) hearing instruments.
    • 9) Identify advantages and disadvantages of custom hearing instruments versus OTE, RIC, and BTE given a patient scenario.
    • 10) Identify advantages and disadvantages of custom hearing instruments given a patient scenario.
    • 11) Identify possible treatment options for asymmetrical and single-sided deafness (SSD) (e.g., CROS/BICROS).
    • 12) Determine the most appropriate hearing instrument given a patient scenario that includes lifestyle, history, test results, and ear canal characteristics.
  • DOMAIN 4: Fit, adjust, program, and service hearing instruments and equipment (15%) (15%)
    • 1) Identify the appropriate adjustment given objective verification outcome results (e.g., sound field aided/unaided discrimination, sound field aided/unaided warble tones or narrow band noise).
    • 2) Identify potential causes of problems or identify the appropriate modification given results from real ear or speech mapping.
    • 3) Identify the appropriate methodologies for modifying the physical fit of earmolds, custom shells, OTE, BTE, and/or RIC instruments given a patient complaint.
    • 4) Identify the appropriate adjustments given subjective validation of results (e.g., COSI, IOI-HA, APHAB, verbal feedback).
    • 5) Troubleshoot and adjust/modify programming of hearing instrument given a patient complaint.
    • 6) Identify or resolve potential hearing instrument problems caused by obstructions, moisture, or battery performance.
    • 7) Troubleshoot pairing and wireless connectivity between hearing-related devices.
  • DOMAIN 5: Counseling and rehabilitation (10%) (10%)
    • 1) Identify the most appropriate patient explanation given results of otoscopic examination and audiometric examination.
    • 2) Identify potential limitations and benefits of amplification.
    • 3) Identify the most appropriate counseling based on subjective validation results.
    • 4) Identify helpful strategies and information for improved hearing and communication in various situations or environments.
    • 5) Identify appropriate manual hearing instrument adjustments that patients, family members, or caregivers can make.
Examination sources