Start Date Part-Time

Care ìnc.

Employment Application Packet

Last Name

Sambola Martinez

Social Security No.

!City

Phone No. +1-305-***-****

First Name

Tiffany Alinie

Street Address

***** *** ***, ***** *iami FL

State Fax No.

Zip

33161

*********************@*****.***

Middle Initial A

Have you ever been convicted of any criminal offense other than minor traffic violations? If so, If hired can you provide proof of please explain. A criminal conviction will be considered only in relation to the job for which you are citizenship or legal right to work? applying. Seriousness and nature of the offense, time elapsed, and rehabilitation will be taken into a Yes.

account. a No

Type of Position Applying For

RN PT OT ST RD MSW HHA

Date Available

11/18/2024

LVN PTA

Position Desired

a Full-Time (yes)

a Part-Time

a Temporary

Office : Specify Position:

Specify anticipated period of work and/or number Salary Expected ! Source of Referral of hours per day

Start Date Employer

Street Address, City State, Zip Code

Position Description Start Date Employer

Street Address, City State, Zip Code

Position Description Start Date Employer

End Date

End Date

End Date

Last Supervisor's Name

Last Supervisor's Name

Last Supervisor‘s Name

Final Position Title

Reason For Leaving Phone

Final Position Title

Reason For Leaving Phone

Final Position Title

Reason For Leaving

Street Address, City State, Zip Code Phone

Position Description

EDUCATION & TRAINING

College University

Graduate? Name of School

Type or Degree or Major

Diploma Subject

Technical

School

Yes

No

City & State

College

University

Graduate? Name of School

Type or Oegree or Major

Diploma Subject

Technical Yes

School No

College Graduate? University

Tehnical Yes

School No

Type or Degree or Major

Diploma Subject

City & State Name of School

City & State

List licenses, foreign languages, computer, data/word processing, office equipment, typing, shorthand, or other skills & training you consider relevant to employment at ProHealth.

Name/Title Mailing Address Phone

I hereby authorize investigation of all statements contained in this application and on my resume, if provided. I certify that such statements are true, and understand that misrepresentation or omission of facts called for in this form, or on any resume provided by me, is cause for termination of employment without notice.

Signature Date

No person shall be denied employment on the basis of race, color, ethnicity, national origin, sex/gender, sexual orientation, religion creed, disability (including HIV status, age, veteran status, marital status or ex-offender status).

Employment is contingent upon furnishing evidence of identity and employment eligibility.

STATE OF CALIFORNIA - f4EALET AND HUM/\N SER\/ICES AGENCY

CRIMINAL RECORD STATEMENT

CALIFORIVIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY TAP[ LICENSING DIVISION

State law requires that persons associated with licensed facilities or Home Care Aide Pegistry applicatJts be tingerprinted and disclose any conviction, A conviction is any plea of guilly or nolo contendere (nc contest) or a verdict of guilty. The fingerprints will be used to obtain a copy ol any criminal history you may have.

Have you ever been convicted of a crime in California ? YES NO

You need not disclose any marjuaria-re/ated offenses covered by the marjuana refofm legislation codified at Health and Safely Code sections 11361,5 and 11361.7.

Have you ever been convicted of a crime from another state, federal court,

military or jurisdiction outside of U,S.? YES NO

Criminal convictions from another State or Federal court are considered the same as criminal convictions in California.

If you answer YES, give details on the back of this page indicating the nature and circumstances of

each crime and the date and the location in which each crime occurred.

You must disclose convictions, including reckless and di unk driving convictions even if:

1.It happened a long time ago;

2.It was only a misdemeanor;

3.You didn't have to go to court (your attorney went for you);

4.You had no jail time or the sentence was only a fine or probation;

5.You received a certificate of rehabilitation;

6.The conviction was later dismissed, set aside or the sentence was suspended.

NOTE: IF THE CRIMINAL BACKGROUND CHECK REVEALS ANY CONVICTION(S) THAT YOU DID NOT DISCLOSE ON THIS FORM, YOUR FAILURE TO DISCLOSE THE CONVICTION(S) WILL RESULT IN AN EXEMPTION DENIAL, LICENSE APPLICATION DENIAL, LICENSE REVOCATION, OR EXCLUSION FROM A LICENSED FACILITY/ORGANIZATION.

I declare under penalty of perjury under the laws of the State of California that I have read and understand the information contained in this affidavit and that my responses and any accompanying attachments are true and correct.

FACILITY/ORGANIZATION NAME FAGILITY/ORGANIZATION NUMBER

YOUR NAME (PRIN T CLEA RLY)

YOUR ADDRESS

CITY

ZIP

SOCIAL SECURITY NUMBER

(SEE PRIVAC \’ STATEMENT ON REVERSE SIDE)

DATE OF BIRTH

DMV LICENSE NUMBER

DATE

SIGNATURE

LIQ 608 (7/15) REQUIRED FORM - NO CHANGE PERMITTED PAGE 1 of 2

1. Instructions to Respondents:

If you have been convicted of a crime in California, another state or in fedeial court, provide the following information:

(You need not disclose any n aiijuana-related ollenses covered by he inaryuana reform legislation codified at Health and Safely Code sections 11361.5 and 11361.7.)

What was the offense?

In which state and city did you commit the offense?

When did this occur?

Tell us what happened. (Use additional sheets of paper iT needed)

I certify under penalty of perjury that the above information is true and correct to the best of my knowledge.

Signature Dale

II. Instructions to Licensees:

If the person discloses a criminal conviction, review the person's statement and discuss it with your Licensing Program Analyst (LPA). Maintain this form in your facility/organization personnel file and send a copy to your LPA.

LIC 500 (7/15) REQUIRED FORM -- NO CHANGE PERMITTED PAGE2OF£

ProHealth

ADDENDUM TO CONTRACT

Caregivers will only be paid on visits and hours in which was assigned. Visit and hours not authorized by office will not be paid on. If family or patient request for further hours, it must be ran by the office and a new contract must be signed.

Caregivers who are working 8 hours or more will be paid a flat rate equivalent to a live in a rate. Live in rates are set according to the case. In cases which caregivers are staying at the home for 24 hours, they will be allowed to sleep 8 hours.

Caregivers who are asked to run errands or groceries, they are eligible for mileage reimbursement. Errands must be done in the same city or county as where client lives.

Caregivers who are assigned a case must be given 48 hour notice if unable to continue on with client. Caregiver must be complete their 48 hour until new caregiver is assigned.

Caregivers are not to be hired by ProHealth Client's outside of ProHealth Care employment. Your employment contract with ProHealth forbids that you take personal hires with Clients who have signed on services with ProHealth Care for at least a year after they have discontinued services with ProHealth.

Print Name: Sign: Date:

ProHeal8h

COMPANION

Caregiver Job Description

-Provide conversation and companionship

-Assist with walking and home physical therapy

-Prepare current and future meals, monitor diet and eating

-Medication reminders

-Assist with bathing, grooming and dressing

-Assist with toileting

HOME HELPER

-Light housekeeping

-Laundry and linen washing

-Accompany to doctors' appointments

-Running errands for clients

-Assist with paying bills

-Prepare grocery list and do shopping

OVERNIGHTS

-All services of companion position

-Assist with evening routine

-Assist as needed through the night

ADDITIONAL RESPONSIBILITIES

-Assist with other related duties as requested or asked by clients

-Call office with any changes to client's health, needs, and/or living conditions

-Communication with clients in a respectful manner

-Treat client and client's property with respect

-Capability to drive or take public transportations to clients home

-Capability to lift a maximum of 25 pounds

The above Caregiver descriptions define the basic duties involved with each position. These list do not cover all responsibilities and duties involved with each position. ProHealth Care Inc reserves the right to change these descriptions in the future as needed.

I have read and understand the duties of the Caregiver Position.

Employee Signature Date

ProHeaIt&

ProHealth Care Inc.

Confidentiality Statement

In order to protect the right of patients to privacy, communication in any form regarding patient's protected health care information shall be confidential. All patient information is to be held in strictest confidence and shall not be disclosed or discussed except in the course of professional responsibilities.

This includes communication between patients and their families/caregivers, between health professionals, the information contained in patients' health care records maintained by the Agency and all OASIS information.

I understand the ethics of confidentiality of patient lnformation and agree to adhere to the above standard.

I understand that violation of the confidentiality standard may be cause for termination.

Employee Signature Date

GALIFORNIA HEALTH AND HUMAIN /2ERVICES AGENCY CALIFORNIA DEPARTMEN T OF SOCIAL SERVICES

PERSONNEL RECORD

(Form to be Gompleted by employee ct the time ot hire)

PERSONAL

CQMMUNITY CARE LIGENSING DIVISION HQME CARE SERVICES BUREAU

FOR HOME CARE ORGANIZATION USE ONLY

NAME OF,HOME CARE OFIQANIZATION . ’

HOME CARE OR GANIZATIÖN ADDRESS : ’

HOME CARE ORGANIZATION NUMBER ’

DATE OF EMPLOYMENT.

D/\TE OF REPARATION ’ ’

HAVE YOU EVER BEEN EMPLOYED UNDER A DIFFEREIVT NAME2 YES NO

DO YOU POSSESS A \/ALID CALIFORNIA DR VER’S LICENSE? YES NO

IF YES, PLEASE LIST ALL NAMES USED.

CDL NUMBER:

TITLE OF POSITION

POSITION INFORMATION

EMPLOYMENT

(List n ost recenr experience firsl. lt addilional space is needed, please atlach a separate page.)

TIME BASE

Notes:

I hereby certify under penalty of perjury that I am 10 years of age or older and that the above statements are true and correct.

I give my permission for any necessary verification.

EMPLOYEE SîGNATUBE "“ “ DATE .

HCS 501 (9/15)

LISTS OF ACCEPTABLE DOCUMENTS

All documents must be UNEXPIRED

Employees may present one selection from List A

or a combination of one selection from List B and one selection from List C.

LIST A LIST B LIST C

Documents that Establish Documents that Establish Documents that Establish Both Identity and Identity Employment Authorization

Employment Authorization oR AND

1.U.S. Passport or U.S. Passport Card

2.Permanent Resident Card or Alien Registration Receipt Card (Form 1-551)

1.Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

1.A Social Security Account Number card, unless the card includes one of the following restrictions:

(1)NOT VALID FOR EMPLOYMENT

(2)VALID FOR WORK ONLY WITH INS AUTHORIZATION

(3)VALID FOR WORK ONLY WITH DHS AUTHORIZATION

3. Foreign passport that contains a temporary 1-551 stamp or temporary 1-551 printed notation on a machine- readable immigrant visa

2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

4. Employment Authorization Document that contains a photograph (Form

1-766)

2. Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)

3. School ID card with a photograph

5.For a nonimmigrant alien authorized to work for a specific employer because of his or her status:

a.Foreign passport; and

b.Form 1-94 or Form I-94A that has the following:

(1)The same name as the passport and

(2)An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.

3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

4. Voter's registration card

5. U.S. Military card or draft record

6. Military dependent's ID card

4a Native American tribal document

7. U.S. Coast Guard Merchant Mariner Card

g U.S. Citizen ID Card (Form 1-197)

8. Native American tribal document

6. Identification Card for Use of Resident Citizen in the United States (Form 1-179)

9. Driver's license issued by a Canadian government authority

For persons under age 18 who are unable to present a document listed above:

7. Employment authorization document issued by the Department of Homeland Security

6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with FOrIT1 1-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

10.School record or report card

11.Clinic, doctor, or hospital record

12. Day-care or nursery school record

Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

Form 1-9 07/17/17 N Pace 3 of 3

STATE OF GALIFORNIA - HE/\LTH ANO HUMAN SERVICEO AGENCY CALIFOFIN IA DEPARTMENT OF SOCIAL SERVICES

STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT SUSPECTED ABUSE OF DEPENDENT ADULTS AND ELDERS

POSITION

Callfornla law REQUIRES certain persons to report l nown or suspected abuse of dependent adults or elders. As an employee or volunteer at a licensed facility, you are one of those persons - a "mandated reporter."

PERSONS WHO ARE REQUIRED TO REPORT ABUSE

Mandated reporters include care custodians and any person who has assumed full or intermittent responsibility for care or custody of an elder or dependent adult, whether or not paid fOr that respohsibility (Welfare and Institutions Code (WIC) Section 15630(a)), Care custodian means all administrator or an employee of most publlc or private facilities or agencies, or persons providing care or services for elders or dependent adults, Including members of the suppoit staff and malfltenance staff (WIC Section 15610.17).

PERSONS WHO ARE THE suBJECT OF THE REPORT

Elder means any person residing in this state who is 65 years of age or older {WIC Section 15610.27). Dependent Adult means any person i‘esiding in this state, between the ages of 8 and 64, who has physical or mental limitations that restrict his or her ability to carry oUt hormal activ ties or to protect his or her rights including, but not limited to, persons who have physical or developmental disabilities or whose physical or mental abilities have diminished because of age and those admitted as inpatients in 24-hour health facilities (WIC Section 15610.23).

REPORTING RESPONSIBILITIES AND TIME FRAMES

Any mandated reporter, who in his or her professional capacity, or within the scope of his or her employment, has observed or has knowledge of an Incident that reasonably appears to be abuse or neglect, or is told by an elder or dependent adult that he or she has experienced behavior constituting abuse or neglect, or reasonably suspects that abuse or neglect occurred, shall complete form SOC 341, “Report of Suspected Dependent Adult/Elder Abuse” for each report of known or suspected instance of abuse (physical abuse, sexual abuse, financial abuse, abduction, neglect (self-neglect), isolation, and abandonment) involving an elder or dependent adult.

Reporting shall be completed as follows:

•If the abuse occuired in a Long-Term Care (LTC) facility (as defined in WIC Section 15610.47) and resulted in serious bodily injury (as defined in WIC Section 15610.67), report by telephone to the local law enforcement agency immediately and no later than two (2) hours after observing, obtaining knowledge of, or suspecting physical abuse. Send the written report to the local law enforcement agency, the local Long-Term Care Ombudsman Program (LTCOP), and the appropriate licensing agency (for long-term health care facilities, the California Department of Publlc Health; for community care faciJities, the California Department of Social Services) within two (2) houi's at observing, obtaining knowledge of, or suspecting physical abuse.

• If the abuse occurred In a LTC facility, was physlcal abuse, but did not result in serious bodily injury, report by telephone to the local law enforcement agency within 24 hours of observing, obtaining knowledge of, or suspecting physical abuse. Send the written report to the local law enforcement agency, the local LTCOP, and the appropriate licensing agency (for long-tei‘m health care facilities, the California Department of Public Health; for community care facilities, the Californla Department oj Social Services) wlthin 24 hours of obselwing, obtalnlng knowledge of, or suspecting physical abuse.

• If the abuse occurred In a LTC facility, was physical abuse, did not result in serious bodily injury, and was perpetrated fry a i'esIdent with a physlclan's diagnosis of demehtia, report by telephone to the local law enforcement agency or the local LTCOP, immediately or as soon as practically posslble. Follow by sending the written report to the LTCOP or the ocal law enforcement agency within 24 hours of observing, obtaining knowledge of, or suspecting physical abuse.

•If the abuse occurred in a LTC facility, and was abuse other than physical abuse, report by telephone to the LTCOP or the law enforcement agency immediately or as soon as practicably possible. Follow by sending the writteh report to the local law enfoicement agency or the LTCOP within two working days.

SOC 041A (3/15) PAGE 1 OF 3

• If the abuse occu red in a state mental hosplta[ or a state developmental center, mahdated reporters shall report by telephone or through a confidential lhternet reporting tool (established in WIC Section 15658) immediately or as soon as practicably possible and submit the report wlthiM two (2) working days of making the telephone report to the iesponsible agency as identified below:

•If the abuse occurred in a State Mental Hospital, ieport to the local law enforcement agency or the California Department of State Hospitals.

•If the abuse occurred in a State Developmental Center, report to the local law enforcement agency or to the Callfornla Department of DeveJopmental Services.

•For all other abuse, mandated reporters sha l report by telephone or thi'ough a confidential internet reporting tool to the adult protective services agency or the local law enforcement agency immediately oi as soon as practically possible. If reported by telephone, a writteh or an Internet report shall be sent to adult protective services or law enforcement within two working days.

PENALTY FOR FAILURE TO REPORT ABUSE

Failure to report abuse of an eldei or dependent adult Is a MISDEMEANOR CRIME, punishable by jail time, fine or both (WIC Section 15C30(h)). The reporting duties are individual, and no supervisor or administratoi shall impede or inhibit the reporting duties, and no person making the i'eport shall be subject to any sanction for making the report (WIC Section 15630(f)).

CONF[DENTIALITY OF REPORTER AND OF ABUSE REPORTS

The identity of all Versons who report uisder WIC Chaptes 11 shall be contîdential and disclosed only aniong APS agencies, local law enforcement agencies, LTCOPs, California State Attorney General Bureau of Medi-Cal Fraud and Elder Abuse, licenslng agencies or their counsel, Department of Consumer Affairs lnvestigators (who învestigate elder and dependent adult abuse), lhe county District Attorney, the Probate Court, and the Public Guardian. Confidentiality may be waived by the ieporter or by court order. Any violation of confidentiality is a misdemeanor punishable by ]ail time, fine, or both (WIC Section 15633(a)).

DEFINITIONS OF ABUSE

Physical abuse means any of the following: (a) Assault, as defined in Section 240 of the Penal Code; (b) Battery, as deflned In Section 242 of the Penal Code; (c) Assault with a deadly weapon or force lil ely to pioduce great bodily injury, as defined in Section 245 of the Penal Code; (d) Unreasonable physical constraint, or prolonged or continual deprivation of food or water; (e) Sexual assault, that means any of the following: (1) Sexual battery, as defined in Section 243.4 of the Penal Code; (2) Rape, as defined In Sectlon 261 of the Penal Code; (3) Rape in concert, as described in Section 264.1 of the Penal Code; (4) Spousal rape, as defined in Section 262 of the Penal Code; (5) Incest, as defined in SectloiJ 285 of the Penal Code; (6) Sodomy, as defined in Section 28G of the Penal Code;

(7) Oral copulation, as defined In Section 288a of the Penal Code; (8) Sexual penetration, as defined In Section 289 of the Penal Code; or (9) Lewd or lasclvious acts as defined in paragraph (2) of subdivislon (b) of Section 288 of the Penal Code; or (f) Use of a physical or chemical restraint or psychotropic medication under any of the following conditions: (1) For punishment; (2) For a period beyond that for which the medication was ordered pursuant to the instructions of a physician and surgeon licensed in the State of Callfornla, who is providing medical care to the elder or dependent adult at the tlme the instructions are given; or (3) For any purpose not authorized by the physician and surgeoil (WIC Section 15610.63).

Serious bodily injury means an injury Involving extreme physical pain, substantial risk of death, or protracted loss or impairment of function of a bodily memher, organ, or of menfal Faculty, or requiring medical intervention, including, but not limited to, hospitalization, surgery, or physical rehabilitation (WIC Section 15610.67).

Neglect (a) means either of the following: (1) The negligent failure of any person having the care or custody of an eldei‘ or a dependent adult to exercise that degree of care that a reasonable person in a like posltion would exercise; or (2) The negligent failure of an elder or dependent adult to exercise that degree of self care that a reasonable person in a like position would exercise. (b) Neglect includes, but 1s not limited to, all of the following: (1) Failure to assist in peisonal hygiene, or in the provision of food, clotl Ing, or shelter; (2) Failure to provide medical care for physlcal and mental health needs. No person shall be deemed neglected or abused for the sole reason that he or she voluntarily relias on treatment by spiritual means through prayer alone in lieu of medical treatment; (3) Failure to protect from health and safety hazards; (4) Failure to pi event malnutrition or dehydration; or (5) Failure of an elder or dependent adult to salisfy the needs specified In paragraphs (1) to (4), inclusive, for himself or herself as a result of poor cognitive functioning, mental limitation, substance abuse, or chronic poor health (WIC Section 15610.57).

Financial abuse of an elder or dependent adult occurs when a person or entity does any of the following: (1) Takes, secretes, appropriates, obtains, or retains real or personal property of an elder or dependent adult for a wrongïul use or with intent to defraud, or both; (2) Assists in taking, secreting, appropriating, obtaining, or rstaining real or personal property of an elder or dependent adult for a wrongful use or with intent to defraud, or both; oi (3) Takes, secretes, appropriates, obtains, or retains, or assÍsts in tal ing, secreting, appropriating, obtaining, or retainlng, real or personal property of an elder oi dependent adult by undua influence, as defined in Section f 56J0.70 (WIC Section 56J0.30(a)).

SOC 341A (3/15) PAGE 2 OF 3

Abandonment means the desertion oi‘ willful forsaking of ah elder or a depandent adult by anyone having cai'e or custody ol that person under circumstances In whlch a ieasonahle person would continue to provide care and custody (WIC Sectlon 15610.05).

lso[ation means any of the following: (1) Acts intentionally committed for the purpose of preventing, and that do serve to pievent, an elder or dependent adult hom receiving his or leer mail or telephone calls; (2) Telling a caller or prospective visitor that an eldei or dependent adult is not present, or does not wish to talk with the caller, or does not wish to meet with the visitor where the statemeht is false, is contrary to the express wishes of the elder or the dependent adult, whether he or she is competent ol not, and is made for the purpose of preventing the elder or dependent adult from havlng contact with family, friends, or concerned persons; (3) False impiisonment, as defined in Section 236 of the Pehal Code; or (4) Physical restraint of an elder or dependent adult, for the purpose of preventing the elder or dependent adult trcm meeting with visitors (WIC Section 15610.43).

Abduction means the l‘emoval from this state and the restraint from returning io this state, or the restraint from returning to this state, of any elder or dependent adult who does not have the capacity to consent to the removal from this state and the restraint from returning to this state, or the restraint from returning to this state, as well as the removal from this state or the i'estiaint from retuining to this state, of any consetvatee without the consant of the conservator or the court (WIC Sectlon 15610.06).

AS AN EMPLOYEE OR VOLUNTEER OF THIS FACILITY, YOU MUST COMPLY WITH THE DEPENDENT ADULT AND ELDER ABUSE REQUIREMENTS, AS STATED ABOVE. IF YOU DO NOT COMPLY, YOU MAY BE SUBJECT TO CRIMINAL PENALTY. IF YOU ARE A LONG-TERM CARE OMBUDSMAN, YOU MUST COMPLY WITH FEDERAL AND STATE LAWS, WHICH PROHIBIT YOU FROM DISCLOSING THE IDENTITIES OF LONG-TERM RESIDE NTS AND COMPLAINANTS TO ANYONE UNLESS CONSENT TO DISCLOSE IS PROVIDED BY THE RESIDENT OR COMPLAINANT OR DISCLOSURE IS REQUIRED BY COURT

ORDER (Tltle 42 United Slates Code Section 3058g(d)(2); WIC Section 9725).

I,, have read and understand my responsibility to report known or suspected abuse of dependent adults or elders, I will comp y with the reporting requirements.

3OC 341A (3/16) PAGE 3 OF 3

ProHealth Care, INC.

PURPOSE

Personnel Administration

STANDARDS OF CONDUCT/ETHICAL BEHAVIOR

Policy No. 1-024.1

To provide an ethical framework and standards of conduct for home care staff in daily activities.

POLICY

All staff will adhere to ProHealth Care, Inc's standards of conduct in their interactions With internal and external customers. These standards will apply to any individual working

Within the organization, including clinical, clerical, administrative, financial, and marketing representative.

PROCEDURE

1.Staffs are expected to complete daily assignments as scheduled or assigned by the supervisor. If an emergency arises, personnel are to notify their immediate supervisor as soon as possible during the workday.

2.Staffs are not to leave the field or their work area without completing the scheduled visits/shifts for that day or their work assignments for that day.

3.All paper work or electronic documentation is to be completed in a timely, accurate manner. Any falsification of documentation in the clinical record and billing record may result in disciplinary action, including termination.

4.All representation of the organization in marketing literature or verbal presentations is to be accurate and truthful. Only care and services that the organization is capable of providing either directly or through written contracts is to be promised to potential referral sources.

5. Whenever a patient is referred to another organization (i.e., hospital, skilled nursing facility, another organization), the patient will receive an explanation of any relationship that receiving organization has to this organization, if any, including financial benefit to the home care organization.

6.All staff is to follow organization policies, especially policies relating to appropriate admitting, transferring, referral, and discharging practices within the organization. Billing personnel are to fallow financial policies for assuring accuracy of bills and billing practices.

7.Staff must not allow their private interest to conflict with those of their patients.

ProHealth Care, INC. Personnel Administration

8.Staffs are not permitted to ash for or accept a loan or gift of money or any object of material value from patients, their families, or caregivers.

9.Failure to adhere to any of the following or falsification of any employment record as well as Documentation within the course of one's workday will result in immediate dismissal:

A.Refusal or creating deliberate failure to carry out instructions given by supervisor.

B.Fighting or creating a disturbance on organization premises or in a patient's home. c Willful idleness or loading during working hours.

D.Unauthorized possession or use of intoxicants or non prescription narcotics

E.Reporting of duty the influence of intoxicants which could interfere with proper work performance.

F.Unexcused absence or abandonment of post

G.Falsification of employment applications, payroll cards, billing records, or any patient clinical record.

H.Theft

I.Deliberate or negligent misuse of organization or patient property.

J.Failure to fallow or unauthorized alteration or organization

Contact this candidate