MOC Training

I hereby attest that I have received the Gold Kidney Health Plan 2023 Model of Care Provider training

Please indicate the method in which you received the MOC training (Required)
Reviewed enclosed printed MOC training materialsReceived training in person from a Gold Kidney Health Plan associate or training seminarCompleted the interactive on-line MOC training module

Provider, Group or Facility Name (Required)

Tax ID Number (Required)

Providers Name(s) (Required)

Authorized Representative’s Signature (Required)

Date (Required)

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