Get Intermountain Healthcare Fiduciary Conflict Of Interest / Independence Questionnaire
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How to fill out the Intermountain Healthcare Fiduciary Conflict Of Interest / Independence Questionnaire online
Completing the Intermountain Healthcare Fiduciary Conflict Of Interest / Independence Questionnaire online is an essential process for ensuring transparency and compliance. This guide provides clear and supportive instructions to help you navigate the form with ease.
Follow the steps to complete the questionnaire effectively.
- Click ‘Get Form’ button to access the form and open it in the online editor.
- Begin with Part 1: General Information. Fill in your name as the trustee and today's date. Ensure that all fields are completed accurately.
- Read the definitions section carefully to understand key terms such as 'fiduciary' and 'conflict of interest' as they apply to your responses.
- Proceed to Part 2: Potential Conflicts of Interest. Start with Section 1.0 Employment. List your current employers, including their names and addresses, followed by your job titles.
- In Section 2.0, indicate whether you hold a position of influence with any organization that is an Intermountain customer, vendor, or competitor. If 'Yes', provide the requested details about your position and the organization.
- Document any boards on which you served in the last year in Section 2.0, part C. Include Intermountain boards and any other relevant affiliations.
- Use Section 2.0, part D, to disclose any additional activities that may represent a conflict of interest.
- Continue to Section 3.0 regarding your family members. Answer whether any family members hold positions of influence related to an Intermountain organization. If 'Yes', provide the requested information for each family member.
- Review your responses carefully to ensure all questions are answered. If any question does not apply to you, write 'NA' next to it to ensure nothing is left blank.
- Once you have filled out the form completely, you can save your changes, and depending on the options available, download, print, or share the completed questionnaire.
Start completing your Intermountain Healthcare Fiduciary Conflict Of Interest / Independence Questionnaire online today.
Intermountain Healthcare emphasizes six core values: integrity, trust, respect, accountability, stewardship, and excellence. These values guide the organization in delivering high-quality, patient-centered care. By adhering to these principles, Intermountain promotes a culture of accountability, which directly influences how conflicts of interest are managed, including through the Intermountain Healthcare Fiduciary Conflict Of Interest / Independence Questionnaire.
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