Individual Certification Test-Only Accept* 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* Provider Information* Provider First Name* Provider Last Name* NPI Number* (e.g., 1234567890) Information completed by* First Name* Last Name Email Address* Relationship to above-named provider (e.g., self, office manager, nurse, other)* CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
