Attachment 1 - Conflict of Interest.pdf

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Attached to
Q522--FY25: Teleradiology| Orlando
Solicitation number
36C24825R0002
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This is a Conflict of Interest Acknowledgment form from VHA Handbook 1660.03 Appendix A, dated November 4, 2015. The form must be completed by Chiefs of Staff, physicians, clinicians, researchers, allied health supervisors/managers, and any VA employees who participate in HCR Contracts.

The form requires signatories to acknowledge they have received, read and agree to abide by VHA Handbook 1660.03 guidance regarding conflicts of interest in contracts or agreements for sharing of HCR. Signatories must confirm they have completed appropriate Tier Level Medical Sharing/Affiliate Office Customer training through the VHA MSO Customer Resource Center. The acknowledgment will be placed in the employee's Electronic Official Personnel File and in the procurement files for any HCR Contracts they are involved with.

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