Utah Provider Code of Conduct Certificate of Understanding and Compliance
For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Select role
*
Step 1- Employee
Step 2- Employer
I need to print a form
Click the print icon in the top right corner to print
Back
Next
Save & Finish Later
Utah Provider Code of Conduct Certificate of Understanding and Compliance
For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Please read the Provider Code of Conduct
Employee Legal Name
*
Legal First Name
Legal Last Name
Employee Email
*
example@example.com
Employer Legal Name
*
Legal First Name
Legal Last Name
Employer Email
*
example@example.com
Program/Facility Name
Signatures
I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law. Please see the Consumer Consent Disclosure at https://www.jotform.com/consumer-consent-disclosure/
I have read and been provided with a personal copy of the DHS Code of Conduct and
Client Rights rule.
I understand this Code of Conduct and Client Rights rule and I agree to comply with it.
I have been trained and understand agency policies and procedures and agree to comply
with them.
I have been trained and understand DHS rules and agree to comply with them.
I had the opportunity to ask questions and received clarification about the Code of
Conduct and Client Rights, Agency Policies and Procedures and DHSrules.
I am aware of my responsibility to report any violations of this Code Rules to DHS to the
program licensor or to the highlighted phone number listed in section 1(i).
Employee Signature
*
Date of Signature
-
Month
-
Day
Year
Date
I provided a personal copy of the DHS Code of Conduct and Client Rights rule to this employee.
This employee has been provided training on Agency policies and procedures and Licensing rules.
I offered this employee the opportunity to ask questions and provided clarification to all questions.
Employer Signature
*
Date of Signature
-
Month
-
Day
Year
Date
Please verify that you are human
*
Preview PDF
Save & Finish Later
Submit
Should be Empty: