Common use of For all employees Clause in Contracts

For all employees. Is the employee legally responsible for the Self-direction member/participant? ☐ YES ☐ NO If the employee is legally responsible for the member/participant, please mark the box that best describes the employee’s relationship to the member/participant. ☐ Parent (biological, legal or adoptive) of member/participant who is a minor ☐ Guardian of member/participant who is a minor ☐ Spouse of the member/participant If the employee is a Legally Responsible Individual (LRI) for the Self-Direction member/participant, State approval to be a paid provider must be submitted with the employment agreement. If the LRI will be a provider for more than one service, State approval must be submitted for each service.

For all employees. Is the employee legally responsible for the Self-direction member/participant? ☐ YES ☐ NO If the employee is legally responsible for the member/participant, please mark the box that best describes the employee’s relationship to the member/participant. ☐ Parent (biological, legal legal, or adoptive) of member/participant who is a minor ☐ Guardian of member/participant who is a minor ☐ Spouse of the member/participant If the employee is a Legally Responsible Individual (LRI) for the Self-Direction member/participant, State approval to be a paid provider must be submitted with the employment agreement. If the LRI will be a provider for more than one service, State approval must be submitted for each service.

For all employees. Is the employee legally responsible for the Self-direction Direction member/participant? ☐ YES ☐ NO If the employee is legally responsible for the Self-Direction member/participant, please mark the box that best describes the employee’s relationship to the member/participant. ☐ :  Parent (biological, legal or adoptive) of member/participant who is a minor ☐  Guardian of member/participant who is a minor ☐  Spouse of the member/participant If the employee is a Legally Responsible Individual (LRI) for the Self-Direction member/participant, State approval to be a paid provider must be submitted with the employment agreement. If the LRI will be a provider for more than one service, State approval must be submitted for each service.

For all employees. Is the employee legally responsible for the Participant/Self-direction Direction member/participant? ☐ YES ☐ NO If the employee is legally responsible for the Participant/Self-Direction member/participant, please mark the box that best describes the employee’s relationship to the member/participant. ☐ : Parent (biological, legal or adoptive) of member/participant who is a minor ☐ Guardian of member/participant who is a minor ☐ Spouse of the member/participant If the employee is a Legally Responsible Individual (LRI) for the Self-Direction member/participant, State approval to be a paid provider must be submitted with the employment agreement. If the LRI will be a provider for more than one service, State approval must be submitted for each service.