NW3 Video Attestation - Peer Mentoring
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Dialysis Facility CCN (6 digit CMS Certification Number):
Title / Role at Facility
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Facility Contact Last Name
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Next Step: Video
Next Step: Questions
Please enter your question(s) related to the content you just viewed. The Network staff will review all submitted questions and post a Q/A document with response to all questions.
Overall how would you rate the content you just viewed? Scale: 5 - Excellent, 4 - Good, 3 - Satisfactory, 2 - Needs Improvement, 1 - Poor
Share at least one take away, action item you identified from the video?
What additional learning modules/topics would you like to see presented in this format?
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