Fill The Form Applicant InformationFirst Name *Last NameDate *Street Address *Apartment, Unit#CityState/ProvinceZIP CodePhone *Email Address *Date Available *Social Security No. *Position Applied for *Are you a citizen of the United States? *YesNoIf no, are you authorized to work in the U.S.? *YesNoHave you ever worked for this company? *YesNoIf yes, when?Have you ever been convicted of a felony? *YesNoIf yes, explainEducationHigh School *Address *From *To *Did you graduate? *YesNoDiploma *AddressCollegeFromToDid you graduate?YesNoDegreeOtherAddressFromToDid you graduate?YesNoDegreeReferencesFull NameRelationshipCompanyPhoneAddressFull NameRelationshipPrevious Employment CompanyPhoneAddressSupervisorJob TitleResponsibilitiesFromToReason for LeavingMay we contact your previous supervisor for a reference?YesNoCompanyPhoneAddressSupervisorJob TitleResponsibilitiesFromToReason for LeavingMay we contact your previous supervisor for a reference?YesNoCompanyPhoneAddressSupervisorJob TitleResponsibilitiesFromReason for LeavingToMay we contact your previous supervisor for a reference?YesNoMilitary Service BranchFromToRank at DischargeType of DischargeIf other than honorable, explainI certify that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.Signature *Date *Criminal Background Check Authorization I hereby authorize Michigan Primary Care Partners and its designated agents and representatives to conduct a public criminal record check in the Michigan State Police- Criminal History Section files located through the States iCHAT Criminal Justice information Center. I Understand this is a public criminal record database.I understand that this report is being generated for all potential vendors, who if contracted would have 24/7 access to the facility based on the contracted work to be performed. I further understand that the results of this check may impact my ability to provide services to Michigan Primary Care Partners in the future.Signature *Date *Send Message /5 0 votes, 0 avg 11 Created on February 14, 2023 HIPPA Test HIPPA Test helps us to increase our knowledge 1 / 5 Which of the following is NOT an example of Business associate functions or activities on behalf of a covered entity? Claims Processing Health Care Insurance Billing Utilization Review 2 / 5 What services may a business associate provide to a covered entity? Management, administrative, and financial services Consultation and data aggregation services Legal, actuarial, and accounting services Accreditation and medical services 3 / 5 What is the purpose of the Security Rule? To enable covered entities to implement new technologies To protect the privacy of individuals' health information To ensure the quality and efficiency of patient care To transmit health information electronically 4 / 5 What was the purpose of HIPAA when President Bill Clinton signed it in 1996? To ensure the rights of individuals to understand their health information To address the use and disclosure of health information To ensure the quality and efficiency of patient care To protect the privacy of individuals' health information while also providing individuals with access to their own medical records. 5 / 5 What is the purpose of the Privacy Rule? To protect individuals' health information To address the use and disclosure of health information To ensure the rights of individuals to understand their health information To provide guidance on the use of health insurance by organizations Your score is LinkedIn Facebook Twitter VKontakte 0% Restart quiz Please rate this quiz Send feedback
