COMPLIANCE HOTLINE

Verge Health fully encourages our board members, employees, and other entities that perform functions on behalf of Verge Health to engage in open dialogue regarding any compliance concerns or questions that may arise. However, we recognize that some individuals may prefer to report or convey information in a confidential or anonymous manner. In order to provide our board members, employees, and other entities that perform functions on behalf of Verge Health an opportunity to report Compliance concerns anonymously and without fear of retaliation, Verge Health provides an alternative method for reporting concerns and access to “The Compliance Hotline”, a confidential/anonymous way for reporting known or suspected improper conduct.

Check this box if you want to report and remain anonymous

Today’s Date:

(*)Reporter’s Name:

Approximate Date of Incident:

(*)Reporter’s Phone #:

Submission Related To

Reporter’s Email:

Reporting As:

Severity:

Location:

(*)Incident Summary:

(*)Describe the details including what happened, who were involved, and where it happened. Provide as much detail as possible to assist with the review and remediation of the issue:

Attach any relevant pictures or other documentation here that could provide additional information regarding the incident and would help in review and resolution.

Attach Documents:

I accept "Terms of reporting"