950 CMR, § 131.03 - Health Care Program Participant Application and Certification Process
(1) Each Health Care Program Participant must
be certified by the Program Manager to participate in the Program .
(2) Health Care Program Participant
certification will be granted only where the prospective Health Care Program
Participant :
(a) is a current Massachusetts
resident;
(b) is an individual
engaged in the provision, facilitation or promotion of a legally-protected
health care activity ;
(c) provides
specific evidence that the applicant is engaged in the provision, facilitation
or promotion of a legally-protected health care activity or the applicant
provides other specific evidence deemed acceptable in the sole discretion of
the Program Manager and General Counsel of the Office of the Secretary of the
Commonwealth.
(d) completes, signs,
dates and provides all necessary information required under M.G.L. c. 9A,
§ 2 and the standard application form provided by the Program ;
(e) agrees in writing to use the applicable
substitute addresses designated by the Program for use by Health Care Program
Participants;
(f) agrees in writing
to abide by
950 CMR
131.00 and all other written Program rules, policies
and procedures;
(g) provides the
residential address and mailing address, if applicable, where the applicant may
be contacted by the Program Manager or their designee and the telephone
number(s) where the applicant may be called by the Program Manager or their
designee; and
(h) provides one or
more addresses the applicant requests not be disclosed for the reason that
disclosure will jeopardize the applicant's safety or increase the risk of
violence to the applicant or members of the applicant's household.
(i) demonstrates custody or guardianship of
any minor children or incapacitated persons also being admitted to the Program
and agrees not to use the Program to evade law enforcement or to avoid
establishing or following child custody or visitation
orders.
(3) Prior to
certification of the application , the Secretary of the Commonwealth may request
additional documentation from the Program applicant.
(4) A properly completed application shall be
effective on the day that it is certified by the Program Manager .
(5) An individual who is certified as a
Health Care Program Participant shall be issued an identification card which
includes their name, identification code, substitute address, certification
expiration date, and applicant's signature.
(6) The term of a Health Care Program
Participant 's certification shall be four years following the effective date of
their certification unless the certification is withdrawn or canceled before
that date pursuant to M.G.L. c. 9A, § 3 or
950
CMR 131.08.
Notes
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