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CONFLICT OF INTEREST STATEMENT <br /> As a provider of services to consumers of ResCare HomeCare, I hereby certify that I <br /> shall not be and have not been a party to any clinical or administrative activity or <br /> decision, including referrals, that places personal gain or interest, or that of a related <br /> party, in conflict the health, safety, security, confidentiality, or well-being of individuals <br /> receiving services from ResCare HomeCare. <br /> - <br /> (Print Name)/{ <br /> Signature <br />