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It also records tube and connector details, including standard prelocked tubing (TRS), available clear/transparent tubing, and tubing variants such as 13M/13T/13D/13W and SlimTube options.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/custom-earmold-swim-plug-order-form-prelocked-tubing-trs/509859/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/custom-earmold-swim-plug-order-form-prelocked-tubing-trs/509859.png","ImageObject",300,407,{"name":42,"@type":43},"Cipher","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-22","2026-10-05",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What information is required in Step 1 for placing an order?","Question",{"text":62,"@type":63},"Step 1 collects shipping and account details, patient contact name, and age (for pediatric orders), plus the claim type and required claim number.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"When is an audiogram required for Acoustically Optimized Venting (AOV)?",{"text":67,"@type":63},"The form states that audiogram is required for Acoustically Optimized Venting (AOV). It is also noted as required for AOV orders.",{"name":69,"@type":60,"acceptedAnswer":70},"What tube and connector options are available for the earmolds?",{"text":71,"@type":63},"Soft earmolds come standard with prelocked tubing (TRS), while hard earmolds use glued tubing. Tube/connectors are available only in clear/transparent, including 13M/13T/13D/13W and SlimTube 3.0/4.0 or Power SlimTube II options with specified tube lengths.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},509859,1792181735,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":96,"preview_page_count":4},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Custom Earmold & Swim Plug Order Form  \nPrelocked Tubing (TRS)  \nStandard for all soft earmolds.  \nEarmold Areas  \nDiagram showing ear areas with names.  \nVentilation Bore AOV Acoustically Optimized Venting  \nHelix/Cymba  \nCrus  \nFirst Bend  \nAnti-Tragus  \nSound Bore  \nTragus  \nConcha Rim  \nIntertragal Notch  \nEarmold Colours  \nClear/Transparent (21)  \nOrange (11)  \nSwim Plug Colours  \nBlue (07)  \n025-0574/Phonak Custom Earmold & Swim Plug Order/Form 27/Jan2023/V14  \nSonova Canada | Phone 905-677-1167 or 1-800-876-1167 | Fax 905-677-7536 or 1-800-814-5799   \nCustom Earmold & Swim Plug Order Form  \nPlease note that changes cannot be made without calling.  \nDate:   /   /   PO\\#:  \nDD MM Year  \n_______________________  \nAttention to  \n(at Phonak) :    \nSTEP 1: General Information  \nShip to Account Number:  \nPhone\\#:  \nCompany Name:  \nAddress:  \nSHIP  \nContact Name (Audiologist/Dispenser):  \nTO  \nFirst Name: ccccccccccc Last Name: ccccccccccc  \nAge of patient:  (Pediatric orders only)  \nClaim Type: m AADL m BCEHP m CNESST m Eastern Health  \nm Greenshield m ISC (NIHB) m Manitoba Health m Nisga’a  \nm ODSP m REGIE m Supp. Health m VAC, DND, RCMP  \nm WCB  province m WSIB  \nm Other:    \nClaim \\# (Required) :    \nL  \nR  \n\n|  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n\n250 500 1K 2K 3K 4K  \n(Please Specify)  \nPlease include audiogram with all orders. Audiogram required for Acoustically Optimized Venting (AOV) .  \n\n| STEP 2: Order Information |  |  |  |  | STEP 3: Configuration |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| c A) Please send earmold(s) only |  |  |  |  | Venting |  |  | Ear Texture |  |\n| c B) Please send earmold(s) with BTE hearing instrument(s):\u003Cbr>c L Model:   Colour:  \u003Cbr>c R Model:   Colour:   Please also send me the following accessories:   c C) Swim Plugs (Please go to step 5) |  |  |  |  | c AOV Acoustically Optimized Vent (Audiogram required)\u003Cbr>OR\u003Cbr>Vent Size (Customer specified):\u003Cbr>c L:   mm c R:   mm |  |  | c Soft c Avg. c Firm\u003Cbr>Canal Length\u003Cbr>Short Med. Long\u003Cbr>c L c R cS L cS R c L c R |  |\n| STEP 4: Earmold\u003Cbr>\u003Cbr>Canal Mold c L c R | Style\u003Cbr>\u003Cbr>Canal Lock c L c R | \u003Cbr>Helix Lock c L c R | \u003Cbr>Semi Skeleton c L c R | \u003Cbr>Skeleton c L c R |  | \u003Cbr>Carved Half Shell c L c R | \u003Cbr>Carved Full Shell c L c R |  | \u003Cbr>Full Shell c L c R |\n\nSTEP 5: Materials and Colours S = Standard  \n\n| c Please indicate if Swim Plug is for a Lyric wearer |  | Colour |  |  |  |  |  |  |  |  |  |  | Lacquer |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  |  | Clear\u003Cbr>(21) | Rose Tint\u003Cbr>(T) | Black\u003Cbr>(06) | Orange\u003Cbr>(11) | Purple\u003Cbr>(08) | Red\u003Cbr>(10) | Blue\u003Cbr>(07) | Green\u003Cbr>(17) | Yellow\u003Cbr>(20) | Beige\u003Cbr>(26) | Light Blue\u003Cbr>(34) | Glossy\u003Cbr>Finish | No Lacquer\u003Cbr>(Clear only) |\n| Acrylic Hard (Lucite) | cS L cS R | S |  |  |  |  |  |  |  |  |  |  | S |  |\n| Silicone Soft 60 | c L c R | S |  |  |  |  |  |  |  |  |  |  | S |  |\n| Silicone Very Soft 40 | c L c R | S |  |  |  |  |  |  |  |  |  |  | S |  |\n| Swim Plug – Floatable Silicone | c L c R |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\nSTEP 6: Tube/Connector Details  \n􀁹 Soft earmolds come standard with prelocked tubing (TRS).  \n􀁹 Hard earmolds come standard with glued tubing.  \n􀁹 Tube/Connectors are only available in clear/transparent.  \n􀁹 13M is standard for acrylic and 13T is standard for silicone.  \n\n| Tubing |  |  |\n| --- | --- | --- |\n| 13 Medium Tube 13M* | c L | c R |\n| 13 Thick Wall Tube 13T | c L | c R |\n| 13 Dry Wall Tube 13D* | c L | c R |\n| 13 Dry Thick Wall Tube 13W | c L | c R |\n\n*Not available with Prelocked Tubing  \n\n| SlimTube | Please indicate\u003Cbr>Tube length\u003Cbr>(00*/0/1/2/3) |  |\n| --- | --- | --- |\n| SlimTube 3.0 (Bolero B, Sky B-M, -P, & -PR) | L | R |\n| SlimTube 4.0 (Lumity, Paradise, Marvel BTEs) | L | R |\n| Power SlimTube II (Sky B-SP & -UP, Naida B-SP & -UP) | L | R |\n\n**00 only available in SlimTube 4.0  \n025-0574/Phonak Custom","cbCaislKokEz37TR","https://ap.wps.com/l/cbCaislKokEz37TR","pdf",1041915,"English","# STEP 1: General Information\n## Claim Type and Claim #\n# STEP 2: Order Information\n## Earmold-only or with BTE instruments\n## AOV ventilation or Vent Size\n# STEP 3: Configuration\n## Venting and ear texture selections\n# STEP 4: Earmold\n## Canal mold, canal lock, helix lock, skeleton styles\n# STEP 5: Materials and Colours\n## Acrylic and silicone material options\n## Swim plug colors and lacquer\n# STEP 6: Tube/Connector Details\n## Prelocked tubing (TRS) and tube variants","[{\"question\":\"What information is required in Step 1 for placing an order?\",\"answer\":\"Step 1 collects shipping and account details, patient contact name, and age (for pediatric orders), plus the claim type and required claim number.\"},{\"question\":\"When is an audiogram required for Acoustically Optimized Venting (AOV)?\",\"answer\":\"The form states that audiogram is required for Acoustically Optimized Venting (AOV). It is also noted as required for AOV orders.\"},{\"question\":\"What tube and connector options are available for the earmolds?\",\"answer\":\"Soft earmolds come standard with prelocked tubing (TRS), while hard earmolds use glued tubing. Tube/connectors are available only in clear/transparent, including 13M/13T/13D/13W and SlimTube 3.0/4.0 or Power SlimTube II options with specified tube lengths.\"}]","Custom Earmold & Swim Plug Order Form - Prelocked Tubing (TRS) | PDF",1791237580]