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Care and Keeping Intake Form

Read & Acknowledge Disclosure

Please take a moment to read the disclosure and acknowledge by filling out the form.

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HB 2661 requires referral agents to have background checks prior to having direct contact with clients.

In addition, a referral agent may not share or sell a client’s placement information to a facility or marketing affiliate without obtaining affirmative consent from the client for each instance of sharing or selling this information.

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