SHA Online Compliance Attestation Name: Entity/Company: Department/Function: CODE OF CONDUCT AND ETHICS – Reference Policy AW1084 I have received and read the Summit Healthcare Association Code of Conduct and Ethics. I understand the Code of Conduct and Ethics applies to my employment/contract with Summit and that following all applicable laws, regulations, policies, and the Code of Conduct and Ethics are conditions of my employment/contract. I will utilize the Code of Conduct and Ethics to guide my decisions and behavior. I will speak up and seek guidance from Summit's Managers, Administration, the Compliance Officer, or contact the Compliance Hotline with any compliance questions or concerns. My electronic signature below reflects I have received, read and agree to comply with the Summit Healthcare Association Code of Conduct and Ethics WORKFORCE MEMBER HIPAA AND CONFIDENTIALITY AGREEMENTReference Policy AW1415 I have received and read the Summit Healthcare Association Workforce Member HIPAA and Confidentiality Agreement. I understand the Workforce Member HIPAA and Confidentiality Agreement applies to my employment/contract with Summit and that following all applicable HIPAA laws, regulations, policies, and the Workforce Member HIPAA and Confidentiality Agreement are conditions of my employment/contract. My electronic signature below reflects I have received, read and agree to comply with the Summit Healthcare Association Workforce Member HIPAA and Confidentiality Agreement. SHA ONLINE COMPLIANCE AND REGULATORY TRAINING I certify I have completed the Summit Healthcare Association Online Compliance and Regulatory Training as required by Federal regulations. I confirm it my responsibility to understand the content, seek clarification for anything I don’t, and report potential non-compliance. I have been provided Summit Healthcare Association contact information and phone numbers should questions or concerns arise. Your Department or Agency/Company Name: Electronic Signature:Accepted file types: jpg, png, pdf, Max. file size: 50 MB.(Allowed file extensions jpg, png, pdf) If you would like copies of the referenced policies, please contact:Natalie Roehlk CHC, CHPC Privacy Officer Office: (928) 537-6939 natalie.roehlk@summithealthcare.net ORLaura Nicks RN, BAN, ACM, CHC Compliance Officer Office: (928) 537-6510 lnicks@summithealthcare.net Δ