Get Code Of Responsibility

Completing the CODE OF RESPONSIBILITY is an essential step for individuals seeking access to the Ohio Department of Medicaid systems. This guide provides clear instructions on how to accurately fill out the form online, ensuring compliance with the necessary security policies.

Follow the steps to successfully complete the CODE OF RESPONSIBILITY.

1. Press the ‘Get Form’ button to acquire the CODE OF RESPONSIBILITY and open it in your preferred online editor.
2. Fill in your name in the designated field, ensuring to include your first name, middle initial, and last name.
3. Enter your work phone number in the provided space, making sure it is up to date.
4. Select your county from the dropdown list provided to indicate your location.
5. Choose the agency type that best describes your position. Options include County Agency, ODM, Contract Employee, Supervisor, State Office, Non-ODM State, County, Contract Company Name, Local Government, Bureau/Work Unit, and Private/non-profit.
6. Input the contract telephone number if applicable, ensuring that it corresponds to your agency.
7. For ACCESS REQUESTED, indicate the specific access needed, such as ODM network/email, CRISE, SETS, SACWIS, MMIS, or other access as required by your role.
8. Carefully read the CODE OF RESPONSIBILITY guidelines provided within the form to understand your obligations.
9. Sign and date the application in the designated areas, ensuring your signature is on the application as the applicant.
10. Obtain your supervisor's signature and date to complete the approval process.
11. Once the form is completed, ensure that all information is accurate, and save changes as necessary.
12. You can download, print, or share the completed form according to your agency's protocols.

Complete your CODE OF RESPONSIBILITY form online today to ensure your compliance and access to essential systems.