Provider Attestation
Your information
Use your name as it appears in your provider record.
Training checklist
Check each item only after completing the required training. Your overall Training Completion Date will be recorded automatically when you select Review and Submit.
Review the current Molina Healthcare of Florida Medicaid Provider Manual.
All training videos must be watched in full. Training completion will be documented through the attestation on this form.
Open Florida Mandated Reporter Training ↗
Open Adverse Incident Reporting Training ↗
Open SAE Reporting & Root Cause Analysis (RCA) Training ↗
Complete Modules 1, 2, 3, and 5 using Molina's training links below.
Molina CLAS attestation
Complete Molina’s separate Provider Attestation before signing this record.
Complete the Molina attestation and retain your confirmation for Pediatric Advancement.
This Pediatric Advancement form does not submit information to Molina or replace Molina’s separate attestation.
Sign & save
Review your information before saving your completed record.
Draw your signature (optional)
Your entries stay in this page until you close or refresh it. Download your PDF and send it, with any completion confirmations, to info@pediatricadvancement.com. Nothing is emailed or submitted automatically.
Download signed attestation ↓
Pediatric Advancement Office — Attach your downloaded PDF manually.
Your entries stay on this page until you close or refresh it. After all required items are complete, select “Review and Submit.” Your Training Completion Date will be recorded automatically and your Certificate of Training Completion will open for you to save as a PDF.
This date is recorded automatically when you successfully select Review and Submit.
