Webinar/Slide Deck Attestation Form

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* 1. Facility Name

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* 2. 6-digit CCN#

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* 3. First and Last Name:

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* 4. Email Address:

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* 5. You are attesting to reviewing webinar and/or slide deck:

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* 6. I understand the project goals and objectives

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* 7. I understand the facility responsibilities and requirements for this project

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* 8. I understand the CMS definition of "referred patient"

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* 9. I received my facility's feedback report and understand the 'focus' for the month

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* 10. Questions, comments, concerns?

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