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Nursing HomesAssisted Living/Board & Care Home and Community Based Services

NORC Library

New Individual Conflict of Interest Screening Template

March 19th, 2019

This document contains information based on the LTCOP Rule, §1324.21(d), Conflicts of Interest. The content is adapted from similar tools developed by State Ombudsman programs, such as Ohio, Texas, Oklahoma, and Iowa. This template is intended for use as a guide when Ombudsman programs develop or revise individual conflict of interest screening tools. States are responsible for adding any state specific requirements, definitions, or processes that may not be included in this document. Additional information on individual conflicts of interest, the provisions in the Rule, and examples of screening tools used by Ombudsman programs can be accessed here.