Attestation form for "Diversity, Equity and Inclusion (DEI): Training for Healthcare Providers and Staff"

Diversity, Equity, and Inclusion (DEI): Training for Healthcare Providers and Staff

This is an attestation of completion of the Provider and Staff training video series "Diversity, Equity, and Inclusion (DEI) Training" from Molina Healthcare. The training can be found here: https://www.molinahealthcare.com/providers/ca/medicaid/resource/cme.aspx

By checking the relevant fields and writing my name below, I attest that I have completed this training.

Question Title

* 1. I am a Provider in

Arizona

California

Florida

Idaho

Illinois

Iowa

Kentucky

Michigan

Massachusetts

Mississippi

Nebraska

Nevada

New Mexico

New York

Ohio

Puerto Rico

South Carolina

Texas

Utah

Virginia

Washington

Wisconsin

Question Title

* 2. I completed the following training modules (Please check all that apply)

Module 1: Introduction to Cultural Competency

Module 2: Health Disparities

Module 3: Specific Population Focus - Seniors and Persons with Disabilities

Module 4: Specific Population Focus - LGBTQIA+ and Immigrants/Refugees

Module 5: Becoming Culturally Competent

Implicit Bias Training

Attestation form for "Diversity, Equity and Inclusion (DEI): Training for Healthcare Providers and Staff"

Diversity, Equity, and Inclusion (DEI): Training for Healthcare Providers and Staff

Question Title

* 1. I am a Provider in

Question Title

* 2. I completed the following training modules (Please check all that apply)

Question Title

* 3. Provider/Staff Name

Question Title

* 4. Clinic/Office Name and Address

Question Title

* 5. Group Tax Identification Number (TIN)

Question Title

* 6. Provider Email Address

Question Title

* 7. Comments/Suggestions