(1) Informs the prospective user that the exercise of the waiver is not in the user's best health interest;
(2) Does not in any way actively encourage the prospective user to waive such a medical evaluation;
(3) Affords the prospective user the opportunity to sign the following statement: I have been advised by (hearing aid dispenser's name) that the Food and Drug Administration has determined that my best health interest would be served if I had a medical evaluation by a licensed physician, preferably one who specializes in diseases of the ear, before purchasing a hearing aid. I do not wish a medical evaluation before purchasing a hearing aid.
(b) Prior to the sale of a hearing aid, every licensee shall be required to advise in writing, in the manner and form prescribed by the board, the person to whom he intends to sell or fit with such hearing aid that such person's best interest would be served by consulting an otolaryngologist or other physician specializing in diseases of the ear, or any other physician duly licensed to practice medicine in this state, if any of the following conditions are found upon examination of such person:
(1) Visible congenital or traumatic deformity of the ear;
(2) History of active ear discharge within the previous ninety days;
(3) History of a sudden or rapidly progressive hearing loss within the previous ninety days;
(4) Acute or chronic dizziness;
(5) Unilateral hearing loss of sudden or recent onset within the previous ninety days; or
(6) Significant air-bone gap.
(c) A copy of any writing or form required to be given to a prospective purchaser or other person by the terms of this section shall be retained in the records of the licensee for a period of seven years following the issuance of each writing.
Note: WV Code updated with legislation passed through the 2012 1st Special Session