I, (enter your name and NPI in the text boxes below), a Baptist Physician Partners' Physician Member, do hereby attest that I have completed the Program to Enhance Relationship-Centered Communication (PERCC) as required by Baptist Physician Partners, LLC and Baptist Physician Partners, ACO, LLC.

ONCE YOU ENTER YOUR NAME AND NPI, PLEASE CAPTURE A SCREEN SHOT AND SAVE/ RETAIN IN YOUR FILES PRIOR TO HITTING "DONE"

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* 1. Physician Name

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* 2. NPI

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