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Medicaid Cultural Competency Training Certification

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- I hereby certify Amida Care participating providers have completed cultural competency training this year or in the last 12 months. I acknowledge this training and certification is required annually by the New York State Department of Health. I declare the above statement is true and accurate to the best of my knowledge. Additionally, this will confirm I hold the authority to complete this certification.
Provider Tax ID Number*
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Provider First Name* Provider Last Name* NPI Number* (e.g., 1234567890)
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