This agreement is entered into by and between ALLWELL GROUP, INC. a Houston Home Health Care Agency, with its principal place of business in Harris County, Texas (hereinafter the “Employer”) and . An individual who resides at , in County, Texas (hereinafter referred as the “Employee”).
IT IS AGREED THAT, the Employer provides health care services to its patients pursuant to the laws, rules and regulations as set forth in federal Medicare and State Medicaid legislation which require the Employer to submit documentation to a fiscal intermediary in order to obtain payment for the services indicated in such documentation, and
THAT, inaccuracies, incompleteness, or delays in the submission of required documentation, as well as failure to submit the documentation, all adversely affect the Employer’s ability to receive full payment in a timely manner, and
THAT, the Employer’s employees who work with the Employer’s patient’s have, as an integral part of their responsibilities to the Employer, a duty to complete and provide the required documentation to the Employer, in an accurate and timely manner and, thereby, receive full timely payment for the services provided to the patients.
THEREFORE, because of the forgoing, the Employees hereby agrees and acknowledges that, prior to the time the employee receives his or her paycheck for each period, the employee must submit, for each pay period, all the Employee’s documentation to the Employers as necessary for the Employer to obtain full and timely payment for all the services provided to its patients,
FUTHER, the Employee hereby agrees and acknowledges that, upon determination of the employer that the required documentation has been provided by the employee to the Employer in a manner that is inaccurate, incomplete or untimely; or upon the determination of the Employer that the employee has failed to provide the documentation that is necessary for the Employer to receive full and timely payments for the services it provides to its patients.
As an employee of the above mentioned corporation, I will abide by the following conditions of employment.
I will comply with the ethical and legal standards set forth by the state of Texas and the health care regulatory agencies of the United States.
As a home care nurse, or other designated home care employee, I agree to comply with policies and procedures as laid out by the Employee Orientation Manual of the Agency relevant to rendering home health care.
I have read the policies and procedures manual of the agency.
I have read the job description and qualifications for the position accepted. I understand the expectations of the Agency.
I will maintain a strict professional relationship with all patients under my care. I will treat all cases with maximal confidentiality.
I will not act or serve as a witness or beneficiary in legal matters regarding clients under my care.
I will not accept gratuities from patient/client(s) of patient/client(s) family members both immediate and extended.
I will not use my personal automobile or the patient/client(s) automobile for transport of the patient/client or family member. I may accompany the client to a doctor’s visit, etc. if a family member provides transportation. If the patient/client agrees a taxi may be used but at the expense of the patient/client. If there is an emergency, the patient/client will be transported by the use of “911” and the emergency vehicle.
I acknowledge that I have read, understand and received a copy of “Infection Control Prevention of Hepatitis B and HIV Transmission in Health Care settings” as established by the U.S. Department of Labor, Occupational Safety and Health Administration. As a part of my orientation, I have attended in-service and received Resource documentation on: Body Mechanics, Fire and Electrical Safety, Infection Control and Universal Precautions and Patient Safety guidelines and Procedures, Personal Safety, and other in-service. A review of the aforementioned will be done annually.
I was instructed on and understand the use: time slips/visit logs, pay and pay schedules, payroll deductions, insurance coverage, in-service/continuing education requirements and clinical documentation requirements.
I will report any incident resulting from omission or bodily issues involving my client immediately to the agency including any suspicious activity or problems that may be related to my clients’ best interest health or welfare.
As a requirement for continued employment, I will provide, but am not limited to providing annual TB screening or bi-annual Chest X-Ray and bi-annual CPR. Automobile insurance and licensure report must be kept current at all times. A random Drug Screen may be required.
All incident and accident involving patients/clients or employees must be reported to the agency immediately after the accident/incident. An accident/incident report must be completed in the Agency office within 24 hours of the event involving the patient/client or employee. All accidents involving a patient must be reported to the physician and events documented in the clinical record.
As an employee of the Agency, I am ineligible to accept employment directly from a patient/client or family for whom I have been assigned.
I, , as an employee of ALLWELL GROUP, INC. agree to represent the agency in a professional manner at all times. If I ever decide to leave ALLWELL GROUP, INC. I will not use the agency’s name in a slanderous manner, by use of terminology that would allude to the agency in not good or reputable fashion. I will not contact any Doctor’s office(s) or Case Worker(s) to notify them that I am no longer with ALLWELL GROUP, INC. in order to influence any future referrals.
ALLWELL GROUP, INC. is a reputable organization that maintains its professionalism through integrity and a credible workforce. We are therefore dedicated to maintaining this professional environment as a team.
I, have read, understand and will comply with all applicable Agency policies.
Employee Volunteer Contract Staff
To ensure the Agency is in compliance with the HIPAA regulations and to ensure the protection of Protected Health Information (PHI) and the prevention of unauthorized use the Agency will authorize those persons allowed to have access to PHI. The Agency must also ensure that what PHI is used by such authorized persons must be what is minimally necessary to perform / carry out the job duty / function.
By signing this agreement, I agree to comply with the agencies policies and procedures pertaining to PHI. Failure to do so will result in progressive disciplinary action including termination as applicable.
I, , hereby authorize ALLWELL GROUP, INC. to investigate all facts contained in my application for employment with this agency, and authorize the release of any and all information by my present and past employers, as the information may be required for reference check. With full understanding of this authorization, I further release all parties from all liabilities for any damages, which may result from finishing of said information.
A copy of this release shall be as valid as the original.
