The following is required to fulfill your compliance requirements. Please initial after each statement demonstrating that you read and understand the requirement:
The Following NON-compliance may result in immediate dismissal or tapering/discontinuation of current medication regimen:
If any compliance requirement is violated you will be required to review and sign a compliance violation log. If you refuse to do this you will be dismissed immediately.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
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