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I, (enter your name and NPI in the text box below), a Baptist Physician Partners' Physician Member, do hereby attest that I have completed one of the Clinical Transformation Heart Failure Guidelines video 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 SUBMIT

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* 1. Select one of the options below:

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* 2. Physician Name

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* 3. NPI

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