utah department of health criminal background screening authorization form

DACS will generate a fingerprint authorization form, which will be printed by the screening agent and provided to the applicant to take to the live scan fingerprinting location (list of locations may additionally generated through DACS as needed). \par \tab \hich\af5\dbch\af31505\loch\f5 (9) Covered providers requesting to renew a license as a health care facility must utilize the Direct Acce\hich\af5\dbch\af31505\loch\f5 \lsdpriority72 \lsdlocked0 Colorful List Accent 6;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 6;\lsdqformat1 \lsdpriority19 \lsdlocked0 Subtle Emphasis;\lsdqformat1 \lsdpriority21 \lsdlocked0 Intense Emphasis; 6bb6913e68dd1250b2d721614c6693683a48b4b783ca48fa58178ce620a157f65158741d2c3a4afdd6557b2c805ae115f8c1edc1cff49e1f06200242701e07cd The Utah Bureau of Criminal Identification is responsible for all arrest and conviction data for the State of Utah. \par \tab \hich\af5\dbch\af31505\loch\f5 (1) As required in Utah Code 26-21-204 the department may review relevant information obt\hich\af5\dbch\af31505\loch\f5 ained from the following sources: This needs to be obtained prior to submitting the application to the office and the results included with the application to the Office. \red255\green0\blue255;\red255\green0\blue0;\red255\green255\blue0;\red255\green255\blue255;\red0\green0\blue128;\red0\green128\blue128;\red0\green128\blue0;\red128\green0\blue128;\red128\green0\blue0;\red128\green128\blue0;\red128\green128\blue128; \lsdpriority61 \lsdlocked0 Light List Accent 4;\lsdpriority62 \lsdlocked0 Light Grid Accent 4;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 4;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 4;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 4; The screened professions listed below require background screening at initial licensure and/or renewal of licensure. Applicant must provide all known substantiated findings of abuse, neglect or exploitation or any felony criminal history to the department upon submission of the criminal history screening application. You will get an auto-generated email with a link to an online disclosure form to acknowledge. \par \tab \hich\af5\dbch\af31505\loch\f5 (G) 62A-3-30\hich\af5\dbch\af31505\loch\f5 5 failure to report suspected abuse, neglect, or exploitation of a vulnerable adult. (a) Results of background screening review, as listed above in R432-35-8(1), (2), and (3), may be reviewed to determine under what circumstance, if any, the covered individual may be granted or retain direct patient access. A student employee moves to a non-student position. {\f535\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f536\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\f537\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\f869\fbidi \froman\fcharset238\fprq2 Cambria Math CE;} \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) over the age of 28 and has convictions or pending charges identified in R432-35-8(1)(a). \par \tab \hich\af5\dbch\af31505\loch\f5 (4) Review of Relevant Information Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities earance for a covered individual. \par \tab \hich\af5\dbch\af31505\loch\f5 Learn more about the recall on Similac, Alimentum and Elecare powder formulas. \par \tab \hich\af5\dbch\af31505\loch\f5 (9) "Direct patient access" means for an individual to be in a position where \hich\af5\dbch\af31505\loch\f5 the individual could, in relation to a patient or resident of the covered body who engages the individual: 493c1b9426881fd2fc08bc6eda7c0ca52e7105c0633a3f37818f08f480102f4ea33c16a0c308ee835a9fc4c82a60ea5db8e375c32dff5d658fc1be7c61d1b8c2 195 North 1950 West e Department determines an individual is not eligible for direct patient access based upon the criminal background screening and the individual disagrees with the information provided by the Criminal Investigations and Technical Services Division or court Cannon Health Building }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 Background Screening Application - Youth Transport Company employeees only. be04197c6d1948eca6cc7b6d3343d49aa00c9819822ec3956e41c4727f29a28aab165b3be596f6a62ddd00dd91d5f42424fd6007b4d3fb84ffbbde073a8cb77f \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 index 6; {\fhiminor\f31574\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic);}{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);} This includes citizens and noncitizens. Please be aware if the fingerprint authorization form is requested, the applicant has to wait for the Office to send the form with the fingerprint authorization before they can be live scanned. Processing includes making a determination of . Division in the Department of Justice (DOJ) collects the information requested on this form as authorized by Business and Professions Code sections 4600-4621, 7574-7574.16, 26050-26059, 11340-11346, and 22440-22449; Penal Code sections 11100-11112, and 11077.1; Health and Safety Code sections 1522, \par \tab \hich\af5\dbch\af31505\loch\f5 (f) a hospice; BCI cannot provide criminal or court-ordered fingerprinting services. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) any felony, class A or B conviction under Utah Criminal Code 76-6-106(2)(b)(i)(A) Criminal Mischief - Human Life; \par \tab \hich\af5\dbch\af31505\loch\f5 (e) Patient family members; and The Background Screening Unit processes screening results for health care providers in Florida currently licensed by the Agency for Health Care Administration. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-5. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) who may have direct patient access; Telephone: (850) 412-4503. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 Authorizing, and Implemented or Interpreted Law: 26-21-9.5}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 BCCU website For background policy questions: Individual Providers (IP) 866-214-9899 Medicaid Contracted Home Care Agency (HCA): 360-725-2560 Nursing Home, Assisted Living, Adult Family Home and Enhanced Services Facilities: 360-688-0715 Most states require that changes to Identity History Summary information be processed through their respective state centralized agency (State Identification Bureau) before any changes can be made to your information. {\*\latentstyles\lsdstimax376\lsdlockeddef0\lsdsemihiddendef0\lsdunhideuseddef0\lsdqformatdef0\lsdprioritydef99{\lsdlockedexcept \lsdqformat1 \lsdpriority0 \lsdlocked0 Normal;\lsdqformat1 \lsdpriority9 \lsdlocked0 heading 1; Please direct inquiries about fingerprinting, Utah criminal records (including expungement or correction procedures) to: Utah Department of Public Safety, Bureau of Criminal Identification (BCI), 3888 West 5400 South CJIS Customer Service Hours:Monday through Friday 8:00 a.m. - 5:00 p.m.Phone:Baltimore City local number: 410-764-4501Toll free number: 1-888-795-0011Fax:410-653-6320Obtaining an Agency Authorization Number: There is no fee required to become an authorized agency to receive criminal background information. \lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 2;\lsdpriority70 \lsdlocked0 Dark List Accent 2;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 2;\lsdpriority72 \lsdlocked0 Colorful List Accent 2;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 2; \par \tab \hich\af5\dbch\af31505\loch\f5 (a) an end stage renal disease facility; \lsdpriority73 \lsdlocked0 Colorful Grid Accent 1;\lsdpriority60 \lsdlocked0 Light Shading Accent 2;\lsdpriority61 \lsdlocked0 Light List Accent 2;\lsdpriority62 \lsdlocked0 Light Grid Accent 2;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 2; All U.S. employers must properly complete Form I-9 for each individual they hire for employment in the United States. \hich\af5\dbch\af31505\loch\f5 \hich\af5\dbch\af31505\loch\f5 record, the individual may challenge the information as provided in Utah Code Annotated Sections 77-18a. The top portion needs to be signed by the applicant, the bottom portion is signed by the non-licensed entity. \lsdpriority62 \lsdlocked0 Light Grid Accent 1;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 1;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 1;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 1;\lsdsemihidden1 \lsdlocked0 Revision; 5cd829496313fbb938871045de13265df05366ef10f50e7e40e941773f27d872f787b3c133c8b026a53240d4376beef0e57dccacf89d6ee8126157aae9f3c44a \par \tab \hich\af5\dbch\af31505\loch\f5 (5) "Cove\hich\af5\dbch\af31505\loch\f5 red contractor" means a person or corporation that supplies covered individuals, by contract, to: \par \tab \hich\af5\dbch\af31505\loch\f5 (c) view medical or financial records. Utah Domestic Violence Request a Conditional Approval You may be eligible to request a conditional clearance per R501-14-7-2 if: You do not reside in a foster home; and OL will process this original clearance and continually monitor this clearance unless the screening agent separates that employee due to termination of their employment with the agency. \par \tab \hich\af5\dbch\af31505\loch\f5 (11) "Engage" means to obtain one's services: \lsdpriority51 \lsdlocked0 List Table 6 Colorful;\lsdpriority52 \lsdlocked0 List Table 7 Colorful;\lsdpriority46 \lsdlocked0 List Table 1 Light Accent 1;\lsdpriority47 \lsdlocked0 List Table 2 Accent 1;\lsdpriority48 \lsdlocked0 List Table 3 Accent 1; \rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid7565795 14. Background Screening -- Health Facilities. Renewing your background screening is no longer necessary if you are in our DACS system and enrolled in Rapback. This includes SAS & DSPD Certified Providers. Crisis Line & Mobile Outreach Team \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a small health care facility; \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sqformat caption;}{\*\cs34 \additive _Equation Caption;}}{\*\listtable{\list\listtemplateid100{\listlevel\levelnfc1\levelnfcn1\leveljc0\leveljcn0 Utah Administrative Code; Topic - Health; Title R432 - Family Health and Preparedness, Licensing; . (a) Department of Public Safety arrest, conviction, and disposition records described in Title 53, Chapter 10, Criminal Investigations and Technical Services Act, including information in state, regional, and national re\hich\af5\dbch\af31505\loch\f5 Utah Domestic Violence Instructions and applications are located at the following web address: https://bci.utah.gov/wp-content/uploads/sites/15/2017/08/ROA-8-24-2017.pdf, https://www.fbi.gov/services/cjis/identity-history-summary-checksChallenge of an Identity History Summary. (a) As required by Utah Code Subsection 26-21-204, if an individual or covered individual has been convicted, has pleaded no contest, or is subject to a plea in abeyance or diversion agreement, for the following offenses, they may not have direct patient access: (i) any felony or class A conviction under Utah Code. 5689811a183c61a50f98f4babebc2837878049899a52a57be670674cb23d8e90721f90a4d2fa3802cb35762680fd800ecd7551dc18eb899138e3c943d7e503b6 {\fbiminor\f31582\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fbiminor\f31583\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fbiminor\f31584\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);} Online Background Check Authorization form for Applicants. Learn more about the Utah Department of Health & Human Services transition. Upon completing the online application, print out the Sircon confirmation page as proof you have paid the FBI/BCI fees. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) does not include a critical access hospital, designated under 42 U.S.C. s, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to the covered provider and the individual explaining the action and the individual's right of appeal as defined in R432-30. Attn: CHRC, Hawaii Criminal Justice Data Center, Department of the Attorney General, 465 South King Street, Room 101, Honolulu, HI 96813. 1-800-273-TALK(8255) fa3528a6243ddf43d7c25673b85d6d0159327aec8477c360d26ee4ca4b144443115d6a8a254be5a1584bd00bc6270050408a24493db959e1259a43140f112567 \par \tab \hich\af5\dbch\af31505\loch\f5 The following groups or individuals are excluded as volunteers and are not required to complete the background clearance process as defined in R432-35: Completely fill out the demographic section at the bottom of the form AND attach a copy of your ID and social security card. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) Adjudications by a juvenile court may\hich\af5\dbch\af31505\loch\f5 If the employee answers "Yes" to #2 or #3 of the form, court dockets or case reports are required to be submitted along with the application. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff \hich\af5\dbch\af31505\loch\f5 c\hich\af5\dbch\af31505\loch\f5 overed providers. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Subtle 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Subtle 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 2; Last, background screenings are required if you are seeking legal guardianship consent for youth ages 12- to 17-years-old and not living in a foster/adoptive home and not receiving services. \par \tab \hich\af5\dbch\af31505\loch\f5 ;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'02. \lsdsemihidden1 \lsdlocked0 toc 3;\lsdsemihidden1 \lsdlocked0 toc 4;\lsdsemihidden1 \lsdlocked0 toc 5;\lsdsemihidden1 \lsdlocked0 toc 6;\lsdsemihidden1 \lsdlocked0 toc 7;\lsdsemihidden1 \lsdlocked0 toc 8;\lsdsemihidden1 \lsdlocked0 toc 9; \par \tab \hich\af5\dbch\af31505\loch\f5 (b) by contract; \par \tab \hich\af5\dbch\af31505\loch\f5 (b) address; and Once the application, forms and fees have been submitted to UDAF, UDAF will send the applicant a "Live Scan Fingerprint Authorization Form" to continue the process. {\fhimajor\f31536\fbidi \fswiss\fcharset163\fprq2 Calibri Light (Vietnamese);}{\fbimajor\f31538\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fbimajor\f31539\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;} Utah Domestic Violence Salt Lake City, Ut 84116, DLBC Contact Info \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 Date of En\hich\af5\dbch\af31505\loch\f5 actment or Last Substantive Amendment: October 1, 2018}{\rtlch\fcs1 \af5 \ltrch\fcs0 \par \tab \hich\af5\dbch\af31505\loch\f5 \hres0\chhres0 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'03. \par Covered Contractor - Direct Access Clearance System Process. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) the Department of Human Services' Division of Child and Family Services Licensing Information Sys\hich\af5\dbch\af31505\loch\f5 tem described in Section 62A-4a-1006; \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R4\hich\af5\dbch\af31505\loch\f5 32-35-6. Health and Human Services Consolidation Information. No appeal is available if you are denied for failure to provide required information, If you close your foster care license, it is your or the screening agents responsibility to inform the Office of Licensing for removal from the ongoing Rap Back system, You are required to disclose all criminal charges, including pending charges, and all supported or substantiated findings of abuse, neglect or exploitation. (2) The Department may allow a covered individual direct patient access with conditions, until the arrest or criminal charges are resolved, if the covered individual can demonstrate the work arrangement does not pose a threat to the saf 1395tt; and 195 North 1950 West \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 7;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 8;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table 3D effects 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table 3D effects 2; \par \tab \hich\af5\dbch\af31505\loch\f5 (a) Signs a criminal background screening authorization form which\hich\af5\dbch\af31505\loch\f5 must be available for review by the department; and 7468656d652f7468656d652f7468656d654d616e616765722e786d6c504b01022d0014000600080000002100b6f4679893070000c92000001600000000000000 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 Social Security Account Number (SSAN). \par \tab \hich\af5\dbch\af31505\loch\f5 (d) Resident family members; f9c6b10f3e4ebfe3566c25ab6b763a8792c9f14e7f7308b7dbd50c195f904fbfa919a175fa04431dd9cf58b73dcd6d4fe3ffdff73487f6f36d2773a8dfb8ed64 \par \tab \hich\af5\dbch\af31505\loch\f5 (c) is\hich\af5\dbch\af31505\loch\f5 not a licensed health care facility within the state. \par \tab \hich\af5\dbch\af31505\loch\f5 (6) "Covered employer" means an individu\hich\af5\dbch\af31505\loch\f5 al who: (5) The department may allow a current employee to continue to work with conditions, during the reconsideration process as defined in each division's background screening guidelines if the employee can demonstrate the work arrangement does not pose a threat to the department and the safety and health of Utah citizens. As the applicant, you are responsible for providing this fee at the time of the live scan fingerprint appointment, The Rap Back system checks state, regional and national databases for criminal records, By submitting an application, you give consent for the Office of Licensing to monitor all relevant databases for as long as you remain licensed or associated with a licensee, The Office of Licensing will issue a screening clearance or denial, according to standards and procedures outlined in, If you receive clearance on your screening, your application will be returned to the background screening agent that submitted it. \lsdpriority72 \lsdlocked0 Colorful List Accent 5;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 5;\lsdpriority60 \lsdlocked0 Light Shading Accent 6;\lsdpriority61 \lsdlocked0 Light List Accent 6;\lsdpriority62 \lsdlocked0 Light Grid Accent 6; \par \tab \hich\af5\dbch\af31505\loch\f5 (f) the Department of Human Services' Division of Aging and Adult Services vulnerable adult abuse, neglect, or exp\hich\af5\dbch\af31505\loch\f5 loitation database described in Section 62A-3-311.1; 432KB Noncriminal Justice Applicant's Privacy Rights Form 1081 Form Instructions 177KB Health Care Mississippi Background Check 192KB Regular Mississippi Background Check 171KB Applicants Living in Another State 169KB

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