The Client Oriented Scale of Improvement (COSI™) is the standard outcome measure most Australian audiology clinics have used for years — the NAL form where your patient nominates listening situations they want to improve, then rates them at follow-up. AudZone takes most of the admin work off your plate so you can focus on the conversation that actually creates value: discussing the patient's listening goals with them.
This guide covers how to get the most out of it day-to-day: what AudZone handles automatically, how to step in when you need to, and how to flow COSI content into your notes, reports, and PDFs.
What AudZone takes care of for you
While you're recording a session, AudZone is quietly working in the background. For COSI specifically, four things happen on their own:
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At an Initial Assessment, AudZone creates a COSI episode for the patient as soon as the session opens. You don't need to start one manually.
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As the patient talks about their listening situations, the AI picks those goals out of the transcript, maps each one to the appropriate NAL category, and saves them onto the episode
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At a fitting appointment, the fitting date is recorded automatically — that's the timing reference for the 5-business-day HSP follow-up rule
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At the follow-up review, the AI extracts the patient's outcome ratings (degree of change, final ability) from the conversation and finalises the assessment when all goals have been rated
If a patient's care runs as you'd expect — assessment, then fitting, then follow-up review where they describe how things have improved — you may not need to open the COSI panel manually at all. The system is designed to fade into the background when things are going smoothly, and let you take over whenever your judgement says you should. This relies on your appointment type being linked to AudZone's Universal appointment types, via appointment type importing.
The next sections cover the parts where you make the difference.
Opening the COSI panel during a session
The Target icon lives in the session control near your recording controls. It shows a small status badge so you can see at a glance where the patient sits in their COSI cycle:
Badge | Meaning |
|---|---|
Yellow "Draft" | Episode created, goals being collected |
Blue "Active" | Phase 1 finalised, waiting for follow-up |
Green "Done" | Phase 2 finalised, full COSI cycle complete |
The number next to the badge tells you how many goals are currently on the episode. Click the icon and the COSI panel slides out from the right of the session page, leaving your session content visible underneath.
The panel has three areas you'll use most:
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The phase indicator at the top: a three-step visual showing Add Goals → Needs Established → Outcome Assessed. The current step is highlighted; completed steps show a tick
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The goals list: one card per goal, showing the situation text, the NAL category, and the rating dropdowns
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The action buttons at the bottom: Establish Needs (locks Phase 1), Complete Assessment (locks Phase 2), and Archive (for when something has gone wrong)
Reviewing and editing goals
The most useful habit is a quick glance at the panel during the consultation, not after sign-off. If the AI has captured three goals but your patient actually mentioned four, you can ask them to repeat the missing one while they're still in the room — much easier than reconstructing it after they've left.
To edit a goal the AI has captured
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Click the goal card to expand it
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Edit the situation text directly if the wording isn't quite right — the patient's exact phrasing is what matters
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Use the category dropdown to change the NAL category if the classification looks off; the goal text itself stays untouched
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Use the rating dropdowns to adjust Initial Ability, Degree of Change, or Final Ability as needed
Phase 1 ratings stay editable until you click Establish Needs. Phase 2 ratings stay editable until you click Complete Assessment. Once a phase is locked, the ratings become permanent — that's what makes the COSI defensible at audit.
To add a goal manually
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Click Add Goal at the bottom of the panel
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Type the patient's situation in their own words — "hearing my wife in the car" — not paraphrased clinical language
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Choose one of the 16 NAL categories (defaults to Other if you skip)
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Optionally rate the Initial Ability now, or come back to it
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Click Add Goal to save. You can have up to five active goals per episode
To reorder goals
Drag any goal by the grip handle on its left side. Priority numbers update automatically.
To remove a goal
Open the actions menu in the top right of the goal card and choose Remove. Available in Draft only; once Phase 1 is locked, removed goals are hidden from view but preserved in the audit trail.
Helping the AI catch goals first time
A few question patterns reliably trigger the goal-extraction AI. Using them as part of your normal conversation means goals get captured the first time — and you spend less time fixing things up afterwards.
Three openers that always work
These wordings score very highly with both the keyword scan and the semantic detection — they're the most reliable ways to open a COSI conversation at an Initial Assessment:
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"What are your top three challenging listening situations?"
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"What would you like to improve with your hearing?"
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"Where do you struggle to hear most?"
For follow-up reviews, the equivalent openers anchor the conversation to existing goals:
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"Let's review your goals — how is [the TV / your wife / work meetings] going?"
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"Let's look at our goals from last time"
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"How are you finding [the specific situation] now?"
Naming the situation back to the patient
When the patient says something general — "I struggle a bit at dinner" — follow up by naming it back: "OK, so dinner with the family — about how often can you hear what's said?" Two things happen at once:
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The AI hears a specific situation ("dinner with family") instead of a vague mention, which is enough to extract a clean goal
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The patient is prompted to give a frequency cue, which auto-rates the Initial Ability for you (more on that below)
Frequency cues that auto-fill the Initial Ability rating
When the patient describes how often they can hear in a situation, the AI maps the phrase to the 1–5 Initial Ability scale automatically — so the rating is filled in when you open the COSI panel:
Patient says | Saved as |
|---|---|
"I can never hear..." / "I always miss..." | 1 — Hardly Ever |
"I sometimes catch..." / "I struggle with..." | 2 — Occasionally |
"About half the time..." / "It's hit or miss..." | 3 — Half the Time |
"I usually can..." / "Most of the time it's okay..." | 4 — Most of the Time |
"I rarely have trouble..." / "I can almost always..." | 5 — Almost Always |
Drawing out a frequency word during the conversation saves you from picking the rating from a dropdown afterwards.
A few things to avoid
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General device-satisfaction questions on their own — "How are the hearing aids going overall?" won't trigger COSI extraction unless a specific situation comes up in the answer. If you want COSI to be picked up at that moment, follow with "And how is [the TV / your wife / the phone] going specifically?"
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Letting the patient stay vague. If the conversation rests at "I just want to hear better", the AI will still save a goal, but it'll be flagged for your review with low confidence. A gentle "In what situations specifically?" turns it into a clean extraction
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The word "goal" used in unrelated chat (sports, for example) is filtered out by design — no need to think about it, but worth knowing the system is sensitive to context rather than just listening for keywords
When the AI extraction misses something
It will happen occasionally — a softly mumbled goal, an accent the AI handles poorly, or a session where the patient described their listening difficulties indirectly rather than as goals. You have three straightforward ways to recover:
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Re-run extraction from the COSI panel. The Extract Goals from Transcript button at the bottom of the panel runs the same AI as the auto-flow, but on demand. It takes about 10 seconds. You'll get a small confirmation message — "3 COSI goals extracted" or "No COSI goals found in transcript"
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Re-run extraction from the note editor. When you've moved on to writing the clinical note, the COSI dropdown in the editor toolbar has the same Extract option. Useful if you've already closed the COSI panel and don't want to navigate back
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Add the missing goals by hand. Use the Add Goal button in the panel. For one or two missed situations, this is often the quickest path
If extraction is missing goals consistently on a particular appointment type, ask your AudZone admin to check the appointment type's settings — there's a capability flag that tells the system whether COSI goals can be established on that appointment. A small configuration tweak usually sorts it.
Adding COSI to your clinical notes
The COSI button (with a small chevron) sits in the rich-text editor toolbar above the clinical note. It appears whenever the patient has COSI data available, or when AudZone recognises the session as one where COSI is likely to be relevant.
Clicking the button opens a dropdown with three insertion options:
Option | Best for |
|---|---|
Goals Only | A clean numbered list of the situation text. Good for clinical notes where the ratings sit elsewhere on the page |
Goals with Ratings | The same list with the scores inline — (Initial: 3/5, Change: 4/5, Final: 4/5). Good for patient-facing summaries and GP referral letters, where the conversational form reads better than a table |
Full COSI Table | A complete table with columns for goal, category, and all ratings. Good for HSP claim documentation and formal reports where an auditor will look |
If the patient has more than one COSI episode (a current one plus completed episodes from earlier appointments), the dropdown shows a Select Assessment chooser at the top so you can pick which episode to insert from. The current active episode is selected by default. Archived episodes don't appear in the chooser — that's deliberate, to keep your options clinically clean.
Click your chosen format and the content is inserted at the cursor position. You'll see a brief "COSI goals inserted" confirmation. The inserted content is editable like any other note content if you want to add commentary around it.
Make sure your text cursor is in the postion where you want the COSI to appear before selecting your option.
COSI in AI-generated documents and reports
This one needs nothing from you. When AudZone drafts any AI-generated document — a follow-up letter, a summary report, a GP referral — the patient's current COSI data is automatically fetched and provided to the AI alongside the rest of the session context. The instructions to the AI tell it to keep the patient's exact goal wording (no paraphrasing), so your goals come through verbatim in the prose. You Just need to make sure the Template has a COSI Section in it for this to work.
Getting a COSI PDF filled in for you
This is one of the most useful features once it's set up. AudZone can fill any PDF form for you — the standard NAL COSI form, your clinic's own version, or any form your funder asks for — using the structured COSI data on the patient's episode.
Step 1 — Set the PDF to generate automatically (recommended)
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Go to Settings → Appointment Types → [your appointment type, for example HSP Aided Review] → Document Flow tab
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Click Add Document and pick your COSI PDF template
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Edit the added Document and Set a condition in plain English — "Generate if COSI goals were discussed during the session" works well for most clinics
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Save
From now on, every session of that appointment type will produce a filled COSI PDF as part of the post-session document set. You'll find it in the Reports tab of the session, ready to review.
Step 2 — Or fill a COSI PDF on demand for a one-off session
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Open the session, then go to Reports tab → Fillable Forms
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Click your COSI PDF template
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The Form Filler dialog opens. Tick which data sources to use — the defaults (transcript, patient info, audiogram, COSI episode) are usually correct. If the patient has more than one COSI episode, you can choose which to use
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Click Auto-Fill & Preview. About 15 seconds later, the filled PDF appears
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Click into any field to edit if needed — it's a real PDF, not an image, so you can type, tick boxes, or add a signature. Download it or close the dialog and it's auto-saved against the session
A few practical tips
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Use the patient's own words. When you're editing the goal text, resist the urge to tidy it up into clinical language. "Hearing my wife in the car" is far more meaningful — for the patient, for the AI, and for the COSI's clinical purpose — than "binaural speech-in-noise comprehension in vehicular environments"
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Glance at the panel mid-consult, not after sign-off. A 5-second check during a natural pause in the conversation saves five minutes of corrections later
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The auto-extraction works best when the patient describes specific situations. If the conversation stays at the level of "I just want to hear better", the AI has nothing concrete to extract. A gentle "In what situations specifically?" helps both your COSI and your patient's clarity about their own goals
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For an annual review, click Duplicate on the previous completed episode to start a fresh cycle with the same goals (ratings cleared). Saves you re-typing the situations if the patient's listening priorities haven't changed
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One active COSI episode per patient at a time. If you need to start over for any reason, archive the current one first (you'll be asked for a brief reason for the audit trail), then create a new one
Advanced Tips
AudZone's COSI extraction can also make use of Picture COSI. You can ask a patient to take photographs on their mobile phone of situations they have difficulty in, from their perspective, prior to your appointment. If you were to upload these to the Session Notes or have them scan the session's QR code. They can upload them in the session and the COSI extraction will identify their situation form the image Automatically using advanced AI It will account for things like visual cues, lighting, Group size, distance from speaker and more.
