Get Vendor Attestation Form

Filling out the Vendor Attestation Form online is essential for vendors supplying goods and services to healthcare organizations. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the Vendor Attestation Form online

1. Click ‘Get Form’ button to access the Vendor Attestation Form and display it in your online editor.
2. Begin by entering the name of the Vendor in the designated field, ensuring it matches the name used on Canadian healthcare requests for proposals.
3. Fill out the street address, city, province/state, and postal/zip code for the Vendor's location.
4. Locate the section where you attest on behalf of the Vendor regarding the Healthcare Industry Representatives (HCIRs). Ensure to list the HCIRs who meet the criteria outlined in the form.
5. Complete the fields about hiring and screening processes for HCIRs, confirming that they do not present security risks.
6. Provide information on the immunization status of HCIRs for the specified diseases. This includes confirming they have shared this information with their vendor employer.
7. Indicate that HCIRs have received the appropriate education and training relevant to the services and goods supplied.
8. Document training received concerning the Canadian Personal Information Protection and Electronic Documents Act (PIPEDA) and related patient privacy laws.
9. Ensure acknowledgment of the principles of handling and non-disclosure of healthcare organization’s confidential information.
10. Confirm that HCIRs are aware of specific provincial directives and inter-provincial trade agreements, if applicable.
11. Attach the name and position of the officer attesting on behalf of the Vendor organization, ensuring the user types or prints this information.
12. Obtain the signature of the attesting officer and include the date of attestation, making sure to input the month, day, and year accurately.
13. Finally, review the completed form for accuracy before saving changes, downloading, printing, or sharing the Vendor Attestation Form as required.

Complete your Vendor Attestation Form online today and ensure compliance with all vendor credentialing standards.