I hereby certify that I am a team member, board member, officer, independent contractor or agent of Duncan Regional Hospital, Inc., or am a medical professional who enjoys professional staff membership and/or privileges at Duncan Regional Hospital, Inc. (“the Hospital”) or any of its entities.

I certify that I have received and read the compliance program of the Hospital and fully understand the requirements set forth in that document to the best of my ability. I shall act in full accordance with all rules and policies of the Hospital. These rules and policies include the Hospital’s commitment to comply with all applicable federal and state laws and the Hospital’s commitment to conduct its business in compliance with the highest ethical standards.

I understand that I will be subject to disciplinary action, including the possibility of termination of medical staff membership/privileges, for violating these policies or the program or failing to report violations as required by the program.