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Molina Healthcare Audiometric Screening Training Attestation
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Training Topics Covered:
Requirements for equipment and screening environment
Document results of audiometric screening
Identify the different types of hearing loss and how it affects the child
Describe the components and proper use/care of the audiometer
(Required.)
I hereby attest that I have successfully completed the Audiometric Screening Training, provided by Molina Healthcare in collaboration with California Medi-Cal Managed Care Health Plans, as required by the Department of Health Care Services. I understand that this training is valid for 4 years from the completion date below.
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Please add your information below in acknowledgement of training.
(Required.)
Name and title of person completing training:
Service Location/Provider Address:
Provider NPI:
Completion Date (i.e. 09/05/2025):
To receive a copy of your completed attestation for your records, please check the box labeled “Send me a copy of my responses via email” and enter your email address. This will ensure the attestation completion page is sent directly to your inbox.
Send me a copy of my responses via email
