Embed Size (px)
Citation preview
Left: Right:250 400020001000500 Hz
dB
VCPSCIC
Previous Scan No:Serial No:
S Standard
Vent Size: Left RightAOV* Customer Specific:
Wax System: S Extension TubemartGuard *Cerustop
Pink 26 Cocoa 22Faceplate Color:
Shell Color:
Brown 28
Transparent 21Pink 26
Audiogram required
S
MC ITC HS FS M P SP
Power Level
Instrument Type
O
S
S
O
O
O O
O
O
O Optional
Options
Side
L R
LR
L R
LR
L R
LRO
O
O
O
O
O
Shell Style
13 Directional
312 Directional
10 (Omni) O
O
O
TC(40/112 ) (50/118) (60/122)
S
S
S
VC = Volume Control PS = Program Switch TC = Inductive Telecoil
UP
O
(70/130)
S
O
* not for SP & UP Power Level
HLHL
250 500 1000 2000 4000
dB
Hz
HL = Hearing Level
Removal Line: Transparent 21 Tan 14 B Nail Griprown 28
S* AOV mandatory for nano
S
WaxbusterCerustop will default unless alternative is selected.
Phon
ak T
ao Q
ord
er fo
rm_N
ov 2
013_
037
v1
24 hr in house $50 per order (+ GST)
Hearing Clinic:
Delivery Address:
Contact Number:
Contact Name:
Client Name:
Date Ordered:
Date Required:
VIP:
Phonak Tao Q (FTC) Order Form Your Account No: 200(Custom Hearing Instruments)
Step1. Order Details
Step 2. Choose a Custom Instrument
Step 3. Complete Audiogram (Required for all Custom Hearing Instruments)
Step 4. Scanned Impression information
Step 5. Product Options
Q15 (Non wireless)
O O O
O
O
Canal Lock Raised VC No Removal line
Product Part Number Qty.
Cedis Electronic Dry Aid Kit
Roger MyLink
MyLink+
Step 7. Choose your Cleaning Maintenance
Product Part Number Qty.
ITE Cleaning Kit (098-0011)(098-0305)
Step 6. Choose your Wireless Communication products (not FTC)
Phonak, Suite 4, Level 2, 21 Solent Circuit, Baulkham Hills NSW 2153. P: 1800 809 321. F: (02) 9634 8373. E: [email protected]
Did you selecta power level& options?
!
Roger / FM Receiver - Via TeleCoil(Please refer to Phonak’s Wireless Communication
order form for more options)
Phonak, Suite 4, Level 2, 21 Solent Circuit, Baulkham Hills NSW 2153. P: 1800 809 321. F: (02) 9634 8373. E: [email protected]
Step 1 - Order Details
Step 3 – Audiogram Required for AOV
Please fill in Client / Order DetailsEnter delivery Date Required
AOV = Acoustically Optimized Vent – Phonak will set the correct vent diameter and style in relation to Audiogram / Shell Geometry / Feedback canceller and required Low Frequency gain – this is the recommended vent type.For AOV audiometric data are mandatory.Select the Ear texture and experience levelSelect Warranty and Rush order details if applicable
Step 2 – Performance Level
Select Performance Level first: Q15
Select the instrument type by choosing the desired battery size and wireless options
Select side
and then choose the required shell style: (CIC / MC / ITC / HS / FS)
Select the required Power level M / P / SP / UP
Select the manual controls; Program Switch / Volume control and T-Coil if required
L R
LR
Step 4 –
Step 5 – Product Options
Model OHS Code
Scanned Impressions
Category
Select the custom product shell, removal line and faceplate Colors / Venting / Wax System
Shell styles
CIC
ITC
FS
Completely In Canal
Mini Canal
Half Shell
Power level Guide
How to decide on different Power levels and what are the side effects;
M Mild to moderate hearing losses (a smaller receiver is used to allow bigger ventings and best cosmetics)
P Moderate to severe hearing losses (for medium size ventings and power paired for best cosmetic)
SP Severe losses (with high power receiver to provide additional gain - should be used for this class only as bigger receiver can have an influence on instruments size)
UP Profound losses (the biggest, most powerful receiver used will allow Halfshell and Fullshell instruments)
MC
HS
Fitting Range
0
20
40
60
80
100
120
125 250 500 1000 2000 4000 8000
Frequency in Hz
HL
indB
Fitting Range
0
20
40
60
80
100
120
125
250
500
1000
2000
4000
8000
Frequency inHz
HL
indB
Fitting Range
0
20
40
60
80
100
120
125 250 500 1000 2000 4000 8000
HL
indB
Power Level
SP Level
UP Level
Phonak Tao Q Order FormCustom Hearing Instruments - Additional Information
M Level
Frequency in Hz
P Level
Full Shell
In the Canal
Please include information about previous scanned impression
Phonak Tao Q15-10 C212PHO T(C3)Phonak Tao Q15-312 C211PHO T(C3)Phonak Tao Q15-13 I114PHO T(C3)
