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Embed code for: Attestation of True & Accurate Documentation
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Of course, her recovery takes priority. Of course, her recovery takes priority. Applied Behavior Analysis Solutions
P.O. Box 832
Pinellas Park, FL 33780
Phone: (727) 492-5369 Fax: (727) 545-8429
Attestation of True and Accurate Documentation
I, _____________________________________, attest that all documents prepared and/or submitted by me as a contractor for ABA Solutions, Inc. are my own work and are true and accurate to the best of my knowledge. During my contractual agreement with ABA Solutions, Inc. to provide behavior analytic/behavior assistant services to individuals in the community, I agree to provide documentation that is true and objective. I will not falsify any documentation nor will I alter any documentation (with the exception of appropriate revisions to documents pertaining to the service).
Documentation referred to in this agreement includes, but is not limited to: data, monthly summaries, behavior programs, functional behavior assessments, annual summaries, client case notes, billing summaries/service logs.
I understand that falsification or inappropriate alteration of any document may result in termination of my contractual agreement with ABA Solutions, Inc. If I have additional questions documentation, I can ask the administrator, agency officers, other office personnel, or a Senior Behavior Analyst with the agency.
Date Position of Contractor at time of signature
Name of Contractor Signature of Contractor
Name/Position of Witness Signature of Witness
** Witness should be agency administrator, officers, or other agency administration personnel