utah department of health criminal background screening authorization form
\ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'07);}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc255\levelnfcn255 Online Background Check Authorization form for Applicants. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 6; Live scan operator will sign and return a copy of the form to be uploaded into DACS by the screening agent. \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: \par \tab \hich\af5\dbch\af31505\loch\f5 (a) by employmen\hich\af5\dbch\af31505\loch\f5 t; BCI cannot provide criminal or court-ordered fingerprinting services. {\fhimajor\f31502\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0302020204030204}Calibri Light;}{\fbimajor\f31503\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} 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. In addition, any such agency in the Federal Executive Branch has also published notice in the Federal Register describing any system(s) of records in which that agency may also maintain your records, including the authorities, purposes, and routine uses for the system(s). 656e74323d22616363656e74322220616363656e74333d22616363656e74332220616363656e74343d22616363656e74342220616363656e74353d22616363656e74352220616363656e74363d22616363656e74362220686c696e6b3d22686c696e6b2220666f6c486c696e6b3d22666f6c486c696e6b222f3e} \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 KEY: health care facilities, background screening}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \par \tab \hich\af5\dbch\af31505\loch\f5 (3) If the Department determines an individual is not eligible for direct patient access based upon the non-criminal background screening and the ind\hich\af5\dbch\af31505\loch\f5 The Utah Bureau of Criminal Identification is responsible for all arrest and conviction data for the State of Utah. Before you get a background screening report about a prospective employee, disclose to the person that you intend to get the report and then get their written authorization allowing you to do that. 4. \lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 5;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 5;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 5;\lsdpriority70 \lsdlocked0 Dark List Accent 5;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 5; \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: \par \tab \hich\af5\dbch\af31505\loch\f5 (b) The dep\hich\af5\dbch\af31505\loch\f5 artment shall rely on relevant information identified in R432-35-8(1), (2), and (3) as conclusive evidence and may deny clearance based on that information. \lsdpriority48 \lsdlocked0 Grid Table 3 Accent 1;\lsdpriority49 \lsdlocked0 Grid Table 4 Accent 1;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 1;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 1; 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. \par \tab \hich\af5\dbch\af31505\loch\f5 (vi) the List of Excluded Individuals and Entities database maintained by the United States Department of Health and Human Services' Office of Inspector General. In giving this authorization, I BCI does not have the authority to modify any records from other state or federal databases. Obtaining Utah Criminal History Records. \par \tab \hich\af5\dbch\af31505\loch\f5 (vi) intervening circumstances; and After you do this, you will receive a Livescan Authorization Form to take with you when you get fingerprints done. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) an aged individual, as defined by department rule; or \par \tab \hich\af5\dbch\af31505\loch\f5 (17) "Volunteer" means an individual who may have unsupervised direct patient access who \hich\af5\dbch\af31505\loch\f5 is not directly compensated for providing services. 1-800-273-TALK(8255) Sources for Background Review. The Background Screening Unit processes screening results for health care providers in Florida currently licensed by the Agency for Health Care Administration. List of Certified Concealed Firearm Instructors, Information for Concealed Firearm Instructors, Concealed Firearm Permit Forms / Instructor Forms, Utah Missing Persons Clearinghouse Functions, Surety Bond and Liability Insurance Information, Documentation of Experience and Qualifications, Concealed Firearm Permit Instructor Applications, Employment/Volunteer Background Check Forms, Application to Become a Qualified Entity for Background Checks on Employees or Volunteers, Authorization to Transfer FBI Rapback Subscription NCPA/VCA, Authorization to Transfer FBI Rapback Subscription School Employees, Authorization to Transfer WIN Rapback Subscription Tow Truck Operators. 1395tt; and (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 (5) If the Department determines an individual is not eligible for direct patient access, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to the covered contractor and the i Bureau of Central Services. For information on obtaining the Out of State Registry, visit this link on our website: https://dlbc.utah.gov/out-of-state-registries, Submit the fee of $37.25 per application in one of the following forms: Company check, cashiers check, or money order made payable to Department of Human Services. I have read the attached Privacy Statement and understand my rights according to this statement. \rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 \chftnsepc \par Call: (801) 538-4242 Department of Human Services, Office of Licensing to provide a copy of those results to me. 534. b175b61bc320c71aa0ecd1a17bd41e35eb16ded0dfdce3dc0fd5c7c26b50a63fd8c34f2643b0a285d7a00c1feee1c3417730b2f56b50866fede1dbb5fe28685b \lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 6;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 6;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 6;\lsdpriority66 \lsdlocked0 Medium List 2 Accent 6; \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 initial requirements information sheet. In the interest of professionalism, public trust and safety for families and individuals, Utah code requires that all persons associated with a licensed facility (owner, director, governing body, employee, agent, provider, contractor or volunteer) who has or will have direct access to children and/or vulnerable adults must pass a criminal background screening. 0c895fcf6720192de6bf3b9e89ecdbd6596cbcdd8eb28e7c365ecc4ec1ff1460f53fe813d3cc7f5b7f020000ffff0300504b030414000600080000002100a5d6 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Classic 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Classic 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Colorful 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Colorful 2; \par \tab \hich\af5\dbch\af31505\loch\f5 (e) Patient family members; and \lsdpriority65 \lsdlocked0 Medium List 1 Accent 3;\lsdpriority66 \lsdlocked0 Medium List 2 Accent 3;\lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 3;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 3;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 3; Authority. \par \tab \hich\af5\dbch\af31505\loch\f5 (4) A covered contractor may provisionally supply a covered individual to a covered provider while clearance is pendin\hich\af5\dbch\af31505\loch\f5 g. The following forms are for those authorized entities seeking to obtain criminal history information on employees or volunteers. Call 801-977-6800 to set up your appointment. dhslicensing@utah.gov. \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) surrounding circumstances; If the background screening report reveals something that may cause you to decide not to hire the person, you must notify them of the results of the . \par \tab \hich\af5\dbch\af31505\loch\f5 (i) the type of offense; 3. \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. Third Party Release (use this form only if criminal history information is to be released to a third party) Download. (7) The Department may allow a covered individual direct patient access with conditions, during an appeal process, if the covered individual can demonstrate the work arrangement does not pose a threat to the safety and health of patients or residents. In the interest of professionalism, public trust and safety for families and individuals, Utah code requires that all persons associated with a licensed facility (owner, director, governing body, employee, agent, provider, contractor or volunteer) who has or will have direct access to children and/or vulnerable adults must pass a criminal background screening. Contact information for states maintaining records at the state level is provided on the State-Maintained Records listing. \hich\af5\dbch\af31505\loch\f5 individual notifying them of the right to appeal in accordance with R432-30. {\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;} footnote text;}{\*\cs19 \additive \rtlch\fcs1 \af5\afs20 \ltrch\fcs0 \f5\fs20 \sbasedon10 \slink18 \slocked \ssemihidden \styrsid14438297 Footnote Text Char;}{\*\cs20 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \super \sbasedon10 footnote reference;}{ 79fdf77c6eadca923b466964cafdf2dd1ffef3cd6fbd7ffff0ed2f5fff319b7a172f4cfcbbbffdeedd3ffef93ef5b0e2d2146ffff4fdbb1fbf7ffbe7dfffebaf Health and Human Services Consolidation Information. Telephone: (850) 412-4503. \par \tab \hich\af5\dbch\af31505\loch\f5 (c) a hospice; \par \tab \hich\af5\dbch\af31505\loch\f5 (i) a nursing assistant; {\flominor\f31552\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flominor\f31553\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\flominor\f31554\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);} \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; \lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority39 \lsdlocked0 TOC Heading;\lsdpriority41 \lsdlocked0 Plain Table 1;\lsdpriority42 \lsdlocked0 Plain Table 2;\lsdpriority43 \lsdlocked0 Plain Table 3;\lsdpriority44 \lsdlocked0 Plain Table 4; 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 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 Salt Lake City, UT 84114-8280. \pndec\pnstart1\pnindent720\pnhang {\pntxta . No renewals will be required for as long as the applicant is actively employed in a licensed DHS or DHS contracted agency. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Subtle 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Subtle 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 2; \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Grid 7;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Grid 8;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 2; If you believe your Identity History Summary contains inaccurate or incomplete information, you have two options for requesting a change or correction: Option 1: Contact the agency or agencies that submitted the information to the FBI. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) a personal care agency. d09bd06aa3566b55134452df4b51026a1f2f97648ebd9952e9dfdb2a1f53784da5500373caa74a35b6243476715e5708b11143cabd0b447b3eccb3609733fc52 (Salt Lake City, UT) The Centers for Disease Control and Prevention (CDC) issued recommendations for vaccinating children 5 years of age and younger against COVID-19. Your SSAN is needed to keep records accurate because other people may have the same name and birth date. \par \tab \hich\af5\dbch\af31505\loch\f5 (\hich\af5\dbch\af31505\loch\f5 6) A covered provider may not allow a covered individual who has been determined to be not eligible for direct patient access to be engaged in a position with direct patient access. \par \tab \hich\af5\dbch\af31505\loch\f5 (2) The covered provider must ensure that the engaged covered individual: SUBJECT: Memorandum Report: State Requirements for Conducting Background Checks on Hom e Health Agency Employees, OEI-07-14-00131 In response to a congressional request, the Office oflnspector General (OIG) initiated two . Utah AMBER Alert and Endangered Missing Advisory. {\*\rsidtbl \rsid2757304\rsid7565795\rsid14438297}{\mmathPr\mmathFont34\mbrkBin0\mbrkBinSub0\msmallFrac0\mdispDef1\mlMargin0\mrMargin0\mdefJc1\mwrapIndent1440\mintLim0\mnaryLim1}{\info{\operator Michael Broschinsky}{\creatim\yr2020\mo4\dy22\hr14\min21} \par \tab \hich\af5\dbch\af31505\loch\f5 (d) Resident family members; Where to apply: Department of Public Safety Bureau of Criminal Identification 4315 South 2700 West Suite 1300 Taylorsville, Utah 84129 Phone: (801) 965-4445 Fax: (801) 969-7065 I need to obtain a copy of my Utah criminal history. Prints will remain active for 60 days to allow for re-employment in a licensed setting. 6bb6913e68dd1250b2d721614c6693683a48b4b783ca48fa58178ce620a157f65158741d2c3a4afdd6557b2c805ae115f8c1edc1cff49e1f06200242701e07cd However, if your application has been submitted for longer than three weeks, you can request a status update by emailing cbsunit@utah.gov. All Utahns should have fair and equitable opportunities to be healthy and safe. \lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 1;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 1;\lsdpriority70 \lsdlocked0 Dark List Accent 1;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 1;\lsdpriority72 \lsdlocked0 Colorful List Accent 1; faadb081f196af190c6a98242f8467912ab0a651ad6a5a548d8cc3c1aafb6121653923699635d3ca2aaa6abab39835c3b60cecd8f26645de60b53531e434b3c2 \par \tab \hich\af5\dbch\af31505\loch\f5 (e) an assisted living facility; \par \tab \hich\af5\dbch\af31505\loch\f5 (a) an end stage renal disease facility; determines there exists credible evidence that a covered individual has been arrested or charged with a felony or a misdemeanor that would be excluded under R432-35-8(1), the Department may act to protect the health and safety of patients or residents in These forms are only to be used by agencies who are authorized by statute, executive order, court rule, court order or local ordinance. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) means an individual: \par \tab \hich\af5\dbch\af31505\loch\f5 (16) "Residential setting" means a place provided by a cov\hich\af5\dbch\af31505\loch\f5 ered provider: }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 . \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) potential risk to patients or residents. 9c7827248a21f056286502866b8ddaa4d684ffea13e827ed5174849121ad780113b137a4f87862cec94af6fc07a0d537206f7ffef9cdeb1fdfbcfee9cd575fbd Headquarters 1395i-4(c)(2). \par \tab \hich\af5\dbch\af31505\loch\f5 (C) 76-9-301.8, Bestiality; b17d4e9cd131584756689f604cd1255a60ec3dfbdcc160c05696cd4bd20f62c82ac7d815580f901dabea3dc5027a25d5dcece7c91322ac909de2881de073bad9 The needs of our communities continue to change as more and more people choose to make Utah their home. \lsdpriority46 \lsdlocked0 List Table 1 Light;\lsdpriority47 \lsdlocked0 List Table 2;\lsdpriority48 \lsdlocked0 List Table 3;\lsdpriority49 \lsdlocked0 List Table 4;\lsdpriority50 \lsdlocked0 List Table 5 Dark; \hich\af5\dbch\af31505\loch\f5 ety and health of patients or residents. {\flomajor\f31511\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flomajor\f31512\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flomajor\f31513\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);} Additional Information: The requesting agency and/or the agency conducting the application investigation will provide you additional information pertinent to the specific circumstances of this application, which may include identification of other authorities, purposes, uses, and consequences of not providing requested information. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35. \lsdpriority45 \lsdlocked0 Plain Table 5;\lsdpriority40 \lsdlocked0 Grid Table Light;\lsdpriority46 \lsdlocked0 Grid Table 1 Light;\lsdpriority47 \lsdlocked0 Grid Table 2;\lsdpriority48 \lsdlocked0 Grid Table 3;\lsdpriority49 \lsdlocked0 Grid Table 4; \par \tab \hich\af5\dbch\af31505\loch\f5 (x) maintenance staff; and \lsdpriority49 \lsdlocked0 List Table 4 Accent 1;\lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 1;\lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 1;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 1; . \par \tab \hich\af5\dbch\af31505\loch\f5 (7) The Department may allow a covered individual direct patient access\hich\af5\dbch\af31505\loch\f5 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 2;}{\s23\ql \li720\ri720\sl240\slmult0\nowidctlpar Processing includes making a determination of . \par \tab \hich\af5\dbch\af31505\loch\f5 (a) a nursing care facility; \hich\af5\dbch\af31505\loch\f5 c\hich\af5\dbch\af31505\loch\f5 onsidered: PRIVACY POLICY ACKNOWLEDGEMENT FORM. This needs to be obtained prior to submitting the application to the office and the results included with the application to the Office. 1-855-323-DCFS(3237) \par \tab \hich\af5\dbch\af31505\loch\f5 (a) As required by Utah Code Subsection \hich\af5\dbch\af31505\loch\f5 534. \hich\af5\dbch\af31505\loch\f5 c\hich\af5\dbch\af31505\loch\f5 overed providers. Applicants also have the option to complete an online version of the Background Check Authorization form . 1-800-371-7897 Code R432-35-5 - Covered Contractor - DACS Process . Authority: The FBIs acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. \lsdqformat1 \lsdpriority1 \lsdlocked0 No Spacing;\lsdpriority60 \lsdlocked0 Light Shading;\lsdpriority61 \lsdlocked0 Light List;\lsdpriority62 \lsdlocked0 Light Grid;\lsdpriority63 \lsdlocked0 Medium Shading 1;\lsdpriority64 \lsdlocked0 Medium Shading 2; 1c57826650ab74c27eb3d20fc3667d1cd66ba341e31514161927f530bbb19fc00506dde4f7f67a7cefee3ed9ded1dc99b3a4caf4dd7c5513d777f7f5c6e1bb7b Health, Administration. Us department of justice criminal background check. By submitting this authorization form, I give my permission to: 1) The . guidelines designated by the Department of Health, and all UNAR requirements. {\leveltext\'03(\'05);}{\levelnumbers\'02;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc2\levelnfcn2\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'06);}{\levelnumbers\'01;}\rtlch\fcs1 \af0 NICS Process. fa1e4542c2173dbfa6fffceabdbb5574940b517940d6909be8bf5c2e17589c37f49c3c3a2b260d823068f50bfd1a40e53e6edc1eb7c6ad429f06a0f91c569a71 e. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) an end stage renal disease facility; 2-35-8(1)(a), the department may deny clearance based on: The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. ffffffffffffffffffffffffffffffff52006f006f007400200045006e00740072007900000000000000000000000000000000000000000000000000000000000000000000000000000000000000000016000500ffffffffffffffffffffffff0c6ad98892f1d411a65f0040963251e5000000000000000000000000f073 \par \tab \hich\af5\dbch\af31505\loch\f5 (i) whom a covered body engages; and 6e22206267313d226c743122207478313d22646b3122206267323d226c743222207478323d22646b322220616363656e74313d22616363656e74312220616363 My personal information and fingerprints may be retained for ongoing monitoring and comparison against future submissions to the state, regional or federal database and latent fingerprint inquiries}. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Smart Hyperlink;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Hashtag;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Unresolved Mention;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Smart Link;}}{\*\datastore 01050000 A student employee moves to a non-student position. 1-855-323-DCFS(3237) Social Security Account Number (SSAN). Multi-Agency State Office Building \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) any felony or class A, B or C conviction under the following Utah Codes: ;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'02. \par \tab \hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) the Department of Human Services' Division of Aging and Adult Services vulnerable adult abuse, neglect, or exploitation database described \hich\af5\dbch\af31505\loch\f5 in Section 62A-3-311.1; This action is part . \par \tab \hich\af5\dbch\af31505\loch\f5 (iii) an individual licensed to engage in the practice of nursing under Title 58, Chapter 31b, Nurse Practice Act; \tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 9;}{ \par \tab \hich\af5\dbch\af31505\loch\f5 (8) A covered provider that provides services in a residential setting mu\hich\af5\dbch\af31505\loch\f5 Utah Admin. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a covered provider for services within the scope of the health facility license. No hard copies of clearances will be required of programs, as all clearance information will be maintained in the DACS program. \par \tab \hich\af5\dbch\af31505\loch\f5 (F) 76-10-1301 to 1314, Prostitution; and {\*\colorschememapping 3c3f786d6c2076657273696f6e3d22312e302220656e636f64696e673d225554462d3822207374616e64616c6f6e653d22796573223f3e0d0a3c613a636c724d The screening or background check includes the submission of fingerprints for clearance on the federal data system. Payment for both the license application fee and the FBI/BCI fingerprint fee of $28.25 ($13.25 FBI/$15 BCI) must be made by credit card during the online license application process. ss Clearance System to run a verification report and verify that each covered individual's information is correct, including: Several states maintain their own record system. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Keyboard;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Preformatted;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Sample;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Typewriter; BGScreen@ahca.myflorida.com. \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a hospice that provides living quarters as part of its services. Covered Individuals with Arrests or Pending Criminal Charges. : 43144 Filed: 08/10/2018 09:20:21 AM. I understand that my personal information including name, DOB, SSN and fingerprints will be used for the purpose of . \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a small health care facility; This form must be presented to the live scan agent AFTER DACS application is submitted in order for the prints to be linked to the applicant in DACS. Utah Domestic Violence \lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 4;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 4;\lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 5;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 5;