Molina Healthcare Audiometric Screening Training Attestation

Question Title

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.

Question Title

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):

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Molina Healthcare Audiometric Screening Training Attestation

Question Title

* 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.)

Question Title

* Please add your information below in acknowledgement of training. (Required.)

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.)

Please add your information below in acknowledgement of training. (Required.)