Provide the following from your past and current employer, assignments or volunteer activities starting from the most recent. Use additional
sheets if necessary.
California State Law requires home health agency's employees to report any and all instances of elder and
dependent adult abuse as well as child abuse.
Following is a list of documents employee must acknowledge and read:
I acknowledge and have signed (when required) the documents above and will abide by all requirements stated
therein. I further acknowledge that I have been instructed of how to proceed in case of witnessing a suspected
elder/dependent adult/child abuse.
Conflict of Interest
I understand that Comfort Assisting, Inc., Home Health Agency have developed rules to protect the patient and
patient's relationship with the agency. I further understand that I will abide by these rules and am aware that
patient has every right to express their concerns to the supervisor.
Policy: Comfort Assisting, 1nc. Home Health Agency staff may use electronic signature on all computer generated documentation. An electronic signature will serve as authentication on patient record documents generated via the organization's Kinnser application.
Purpose: To utilize current technology in the provision of patient care
Responsibility: All personnel
Comfort Assisting, Inc. Home Health Agency staff may create patient documentation via computer system.
For the purpose of the electronic medical record and documents printed from the electronic medical record, the employee's use of an Electronic Signature Passcode after authenticating with their system log in. The organization-based application administrator will issue each employee a system username and a temporary password. The user will create a new password upon initial log in to the organization's Kinnser application.
The employee will generate an Electronic Signature Passcode that will only be accessible to them.
Each user will be required to change her/his Login authentication password.
Each employee will review documentation and make necessary corrections per organization policy to documents returned by a case manager, at which time the clinician will be required to re-enter the Electronic Signature Passcode to re-submit the documentation.
In the event of system downtime that results in the employee's inability to use the electronic documentation, the employee will complete records manually.
Each user must keep their login username authentication password and Electronic Signature Passcode confidential. Only the user and at organization-based administrator may reset a user's login authentication password.
Upon termination of employment, the administrator will immediately disable the employee user's credentials to prevent access to the electronic medical record.
I understand that Comfort Assisting, Inc. Home Health Agency staff may use electronic signatures on all computer-generated documentation. An electronic signature will serve as authentication on patient record documents and other organization documents generated in the electronic system.
For purposes of the computerized medical record and other organizational documentation, I acknowledge that the combined use of my Electronic Signature Passcode and Login authentication password will. serve as my legal signature. I further understand that an organization-based administrator will issue my initial employee password and that I will create an Electronic Signature Passcode within the software application.
Login authentication password must be updated every 6o days by the user, as well as on an as needed basis in the event system security is breached. I understand that prior to exporting documentation to the organization server, I must review and authenticate by use of electronic signature, my documentation on the field-based or office computer.
I understand that I am responsible for the security and accuracy of information entered into my organization's Kinnser application, and as such, I will:
The information contained in this application is correct to the best of my knowledge. I hereby authorize Comfort Assisting lnc. and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. l understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences, employment history, education background, character references, drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.
I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Comfort Assisting, Inc. or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I hereby release Comfort Assisting, Inc. the -Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.
SEASONAL INFLUENZA VACCINE INFORMATION
*FLU SEASON IS FROM OCTOBER TO MARCH*
TB SCREENING QUESTIONNAIRE
(To be completed on hire date and annually thereafter)
Do you currently have any of the following symptoms?
EMPLOYEE COMMUNICATION AGREEMENT
I understand that Comfort Assisting, Inc., Home Health Agency have developed means for internal communication and will use them and encourage their use among others.
Comfort Assisting, Inc., Home Health Agency employees will participate in regular Quarterly Meetings during which employees will be informed on recent company activities, changes in workplace and employee recognition.
Comfort Assisting, Inc., Home Health Agency encourages employees who have suggestions that they do not want to offer publicly, to write them down and leave them in the Suggestion Box located in the company's office. If this is done anonymously, agency's management will take every measure to preserve the employee's privacy.
Handling of Complaints:
Employees who have a job-related problem, question or complaint, should first discuss it with their immediate supervisor. At this level employees usually reach the simplest, quickest and most satisfactory solution. If the employee and supervisor do not solve the problem, agency encourages employees to contact the manager.
Home Health Aide (HHA)
A paraprofessional person who is specifically trained, competent and performs assigned functions of personal care to the patient in their residence under the direction, instruction and supervision of the registered nurse (RN).
Works indoors in Agency office and patient homes and travels to/from patient homes.
Ability to perform the following tasks if necessary:
Speech Language Pathologist (SLP)
A Speech Language Pathologist (SLP) administers speech therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director ofNursing. Speech therapy senrices are furnished only by or under the supervision of a qualified speech pathologist or audiologist.
Supervised by: Director of Nursing
Registered Physical Therapist (PT)
A Registered Physical Therapist (PT) administers physical therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Patient Care Services.
Registered Nurse (RN)
A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of patient Care Services.
Licensed Vocational Nurse (LVN)
A qualified Licensed Vocational Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Registered Nurse. Services are furnished in accordance with Agency policies.
Medical Social Worker (MSW)
A Medical Social Worker (MSW) provides social work services to patients on an intermittent basis in their place of residence. This is perfom1ed in accordance with physician orders and plan of care under the direction and supervision of the Director of Patient Care Services. Services are furnished by a qualified social worker or by a qualified social work assistant under the supervision of a qualified social worker.
Occupational Therapist (OT)
An Occupational Therapist (OT) administers occupational therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Patient Care Services.
Licensed Physical Therapy Assistant (LPTA)
A Licensed Physical Therapy Assistant (LPTA) administers physical therapy to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Registered Physical Therapist (PT).
Registered Dietitian Nutritionist (RDN)
A qualified Registered Dietitian Nutrition (RDN) is responsible for the planning and delivering nutrition care of patients in accordance with the physician's diagnosis and requirements of regulatory agency. Functions a member of the health care team to asses and provided nutritional intervention for all patients identified at nutritional risk by the health care team. Develops orientation, education, knowledge and skills as appropriate for the patients, including the adolescent, geriatric and adult patient, plus terminal ill patient. The RDN analyses body composition, supplement evaluation and recommendation- implementing behavior modification and life style management techniques.
Works indoors in Agency office and patient homes and travels to /from patient homes.