Get Ca Dhcs Pm100 2009

Filling out the CA DHCS PM100 is a crucial process for reporting hearing testing data for schools in California. This comprehensive guide will walk you through each section and field of the form, helping you complete it accurately and efficiently.

Follow the steps to fill out your CA DHCS PM100 form online.

1. Click the ‘Get Form’ button to access the CA DHCS PM100. This will allow you to view and fill out the form directly in your online editor.
2. Begin by entering the identifying information at the top of the form. Include the reporting school year and your District’s CDS code number, which you can find in the California Public School Directory.
3. In Column (1), list all the grades present in your district. Next, in Column (2), provide the number of pupils enrolled in each grade based on the October report from CALPADS.
4. For Column (3), enter the number of pupils screened per Section 2951(c) of Title 17. This includes all grades, so ensure you collect accurate data for each level.
5. In Column (4), record the number of pupils who failed both threshold tests as per Section 2951(d). This data is crucial for understanding the screening outcomes.
6. For Column (5), indicate the number of pupils who were referred for medical and/or audiological evaluation based on the failures noted in Column (4).
7. In Column (6), provide the number of pupils who were examined by a doctor and/or audiologist or are currently under treatment, derived from the previous outcomes.
8. If applicable, summarize any special education services used for audiometric and audiological evaluations and attach extra information if needed.
9. Check the appropriate boxes for the testing personnel involved in the screening, including details if testing was contracted out.
10. Finally, ensure all sections are complete and accurate, then submit the report to the specified address or via the indicated email.
11. After filling out the form, you can save your changes, download a copy, print the filled document, or share it as required.

Complete your CA DHCS PM100 form online today to ensure timely submission.