CMS Compliance Form

Please fill out all parts of this form and submit it to complete the training.

I have read the Network Health Vendor Conflict of Interest Policy (posted on GrandCare Slack), and am disclosing the following conflicts as of this date.

I agree to update my Conflict of Interest disclosure form annually. GrandCare will notify me when it is time to update it.

I accept the Network Health Code of Conduct (posted on GrandCare Slack).

I have completed training in: general compliance; fraud, waste, and abuse; and HIPAA.

I understand how to report non-compliance, FWA, and HIPAA violations, and I understand that I can report anonymously via the Network Health hotline 877-700-7020 and the Network Health link

I acknowledge that the Network Health Regulatory Compliance program document (posted on GrandCare Slack) has been made available to me.

I acknowledge that Network Health has a hotline number 877-700-7020 which can also be found at

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