Missouri Credentialing Board

Renewal Certification Ethics


   

I, , have read and will abide by the current MCB Treatment Ethics Code and/or the current MCB MRSS, MRSS-P or CRPR Ethics Code listed on the web site www.missouricb.com under the MCB Ethics Codes link.

AUTHORIZATION AND RELEASE

I, , hereby certify all of the information given herein is true and complete to the best of my knowledge and belief.  I also authorize any relevant investigations, or the release of personal information to the Missouri Credentialing Board, its agents, or contractors pursuant to this application/renewal procedure.  I understand falsification of any portion of this application/renewal will result in my being denied credentialing, or revocation of same upon discovery.

I further agree to hold the Missouri Credentialing Board and its Board Members, officers, agents, staff, peer evaluators and examiners, free from any civil liability for damages or complaints by reason of any action that is within the scope and arise out of the performance of their duties which they, or any of them, may take in connection with this application/renewal, the examination, the grades with respect to any examination, and/or the failure of the MCB to issue me said credential or renewal.

This Authorization and Release shall also apply to personal information requested by the Board at any time following credentialing in connection with any investigation concerning allegations that could lead to disciplinary action against me.

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Missouri Credentialing Board https://missouricb.com
Signature Certificate
Document name: Renewal Certification Ethics
lock iconUnique Document ID: 30a5f02cbdf0b9d0e5fa056e2b5dfdc52a48d339
Timestamp Audit
September 6, 2017 2:45 pm CSTRenewal Certification Ethics Uploaded by Stacey Langendoerfer - MOCredentialingBoard@gmail.com IP 71.51.220.202