The California PM 101 form is an application for registration as a school audiometrist. It is used by individuals who conduct hearing tests in California schools. This registration is necessary for those who meet specific training and employment criteria as outlined in the Education Code.
Individuals who are employed as school audiometrists or qualified supervisors of health must complete this form. This includes school nurses, health department employees, and those with relevant California credentials in fields such as speech and hearing or education for the deaf and hard of hearing.
To successfully submit the PM 101 form, applicants must provide:
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A completed PM 101 application form.
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A transcript of records or official grade cards showing satisfactory completion of required training in audiology and audiometry.
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A registration fee of $10, payable to the California State Department of Health Care Services.
All these documents should be mailed together to the designated address provided in the form instructions.
Send the completed PM 101 form, along with the official transcript and registration fee, to:
California Department of Health Care Services
Accounting Section, Cashiers MS 1101
P.O. Box 997413
Sacramento, CA 95899-7413
If you have any questions regarding the PM 101 form or the registration process, you can reach out to the Hearing Conservation Specialist at (916) 323-8087. They can provide assistance and clarify any concerns you may have.