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Cultural Competency Training Attestation Form

Fidelis Care offers training and resources on Cultural Competency to our participating provider network.

Providers may complete Fidelis Care's Cultural Humility training to fulfill this requirement if they do not have their own curriculum available in accordance with CMS requirements.

Provide full name of provider that completed the training
Please note this information is voluntary
If email address differs from the person taking the training please provide both email addresses

  Language(s) Spoken (NCQA Requirement)

Language(s) Spoken (NCQA Requirement) Please note this information is voluntary
Enter Date: mm/dd/yyyy

I have received and reviewed Fidelis Care's posted materials for the Cultural Humility Training for Healthcare Professionals.

I have received and reviewed Fidelis Care's posted materials for the Cultural Humility Training for Healthcare Professionals

I have completed my own Cultural Competency training course in compliance with CMS guidelines.

I have completed my own Cultural Competency training course in compliance with CMS guidelines.