Attestation of Annual Employer EVV Training
Name of Individual Receiving Services
*
First Name
Last Name
Name of Person Who Completed EVV Training (this MUST be the Employer or Designated Representative)
*
First Name
Last Name
Role of Person Who Completed EVV Training
*
Please Select
Individual Receiving Services
Designated Representative
Employer
This person should be the same as the person who signs timesheets and is considered the employer in Vesta.
Email address of person who completed EVV training (employer or representative)
*
This is where the confirmation email will be sent.
Date Training Was Completed
*
-
Month
-
Day
Year
Date
Please check to indicate your understanding of and agreement with the following statements:
*
I certify that I have taken the training provided by VESTA for CDS employers.
I understand that it is my responsibility to train my employees to correctly and consistently clock in and out of VESTA
I understand that it is my responsibility to ensure that my employees clock in and out of VESTA for EVV services every day that they work.
Based on the VESTA EVV training, I understand and agree to the following:
*
My employee(s) and I must be 90% compliant with approved visits through VESTA.
I understand which phones/tokens are acceptable for clocking in and out.
I am responsible for keeping my FMSA up to date on any address or phone number changes.
I know which services require EVV and that those services NOT covered by EVV must be submitted via a timesheet.
I agree that if my program requires it, I will ensure that my employee(s) keep a written record of services provided in the home.
Signature of the Employer (the person that took the EVV training)
*
Please upload a PDF of your EVV Training Certificate
*
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