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.
1.I am a Provider in(Required.)
2.I completed the following training modules (Please check all that apply)(Required.)
3.Provider/Staff Name(Required.)
4.Clinic/Office Name and Address(Required.)
5.Group Tax Identification Number (TIN)(Required.)
6.Provider Email Address(Required.)
7.Comments/Suggestions(Required.)