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Attestation form for "Culturally and Linguistically Appropriate Services: Training for Healthcare Providers and Staff"

Culturally and Linguistically Appropriate Services: Training for Healthcare Providers and Staff

This is an attestation of completion of the Provider and Staff training video series "Culturally and Linguistically Appropriate Services" 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.)