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<DIV>Pursuant to OAR 858-010-0060(2), licensees must provide to the Board a named “qualified person” who will intercede for client welfare, maintain and access client records to ensure confidentiality, and make necessary referrals in case of death or incapacity of the licensee. Attached is the Qualified Designated Person form to be completed and returned to our office. If you do not have client contact or have not seen clients in more than seven years please indicate in the section where the name of the designated person should be. Also, if you work for a corporation that is the <EM>owner of records</EM> simply indicate the name of the corporation. Thank-you. Kelli 503-373-1146</DIV>
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<DIV><FONT face=Tunga><FONT size=3><STRONG>K</STRONG>elli <STRONG>K</STRONG>elly</FONT></FONT></DIV>
<DIV>Licensing Coordinator, OBPE<BR>3218 Pringle Road SE #130<BR>Salem, OR 97302-6309<BR>503-373-1146 <BR>FAX (503) 378-4404</DIV>
<DIV><A href="http://www.obpe.state.or.us/">www.obpe.state.or.us</A> <BR> <BR>Please participate in our Customer Survey at: <A href="http://library.state.or.us/services/surveys/survey.php?sid=82">http://library.state.or.us/services/surveys/survey.php?sid=82</A> <BR></DIV></BODY></HTML>