Embedded Files
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Acknowledge Handbook Receipt
I acknowledge receipt of UMS Homecare Employee Handbook. In consideration of my employment, I agree to read and abide by the rules and the policies of this handbook. Since the information, policies, and benefits described in this booklet may be subject to change, I understand and agree that any such change can be made unilaterally by the company in its sole and absolute discretion, and that material changes will be made known to employees through the usual methods of communication within a reasonable period of time.
Drug & Alcohol Policy
A. PURPOSE
To provide a controlled substance, drug and alcohol-free workplace for the safety of all employees (leased, hired, or otherwise) and customers. In order to further this objective, the following rules governing alcohol and illegal drugs and inhalants in the workplace have been established.
B. POLICY
1. The illegal manufacture, distribution, dispensing, possession, sale, purchase, receipt or transmittal of controlled substances, or an attempt to any of the foregoing, while on UMS Homecare or Patient property or on company related business is prohibited.
2. The unauthorized possession of alcohol or any alcoholic beverage on Company property or on Company related business is prohibited.
3. Being under the influence of alcohol or other illegal or intoxicating drugs or inhalants while on Company property or on Company related business is prohibited.
4. The unauthorized use or possession of prescription drugs or nonprescription over-the-counter drugs on Company property or Company related business is prohibited.
5. Employees who violate this policy will be subject to appropriate disciplinary actions, including termination.
6. This policy applies to all employees of the Company regardless of rank or position, and includes temporary and part-time employees.
C. TESTING
1. Testing of employees. All present employees (leased, hired or otherwise) will be requested to sign an Informed Consent and Release of Liability form. Employees may be tested for the presence of alcohol, drugs including inhalants and/or controlled substances in the event any of the following situations occur:
a. There exists a reasonable suspicion or belief that an employee is at work under the influence of drugs, alcohol, inhalant, or a controlled substance;
b. There exists a reasonable suspicion or belief that drugs, alcohol, inhalants or a controlled substance are affecting an employee’s job performance, attendance patterns, conduct, or safety of workplace actions;
c. The employee is suspected of having caused or contributed to an on-the-job accident;
d. When required by a customer or Company pursuant to the customer’s drug testing policy. Such testing is not considered a Company drug test and may be subject to the customer’s rules regarding drug tests.
2. Voluntary. In all instances, testing will be performed only with the applicant or employee’s knowledge and consent. Refusal to submit to requested testing, however, may result in disciplinary action including termination of employment.
3. Company Testing. Urine specimens will be obtained at the Company’s office, lab, testing facility; however, in the event of an accident or injury, samples may be obtained at an appropriate hospital, clinic, emergency room, or doctor’s office.
4. Test Results. A positive test shall mean the presence of alcohol, an inhalant or other drug or controlled substance has been found. An attempt by an employee to switch, adulterate, or tamper with any test result or sample submitted for medical testing, or otherwise interfere or attempt to interfere with the testing processes, shall result in immediate termination.
D. CONFIDENTIALITY
The Company shall make all reasonable attempts to keep the results of a positive drug test confidential. Such results shall be released to Company personnel only on a need-to-know basis. All positive written test results will be stored in a confidential file and be filed only by authorized Company personnel and kept only at the company.
E. DISCIPLINARY ACTION
Employees suspected of violating any of the policies contained herein may be suspended or removed from the workplace pending a complete investigation. Employees testing positive for drugs, alcohol, inhalants or other controlled substances will be subject to immediate discharge. Any employee who is otherwise found to have violated the policies herein will be subject to disciplinary action, including termination of employment. Should the determination be made that no violation of the policies contained herein have occurred, the employee will be reinstated without penalty.
F. EXCEPTION
An employee who possesses or uses a drug authorized by a licensed physician or medical practitioner through a prescription, specifically for the employee’s use while on the job, and whose facilities are not noticeably impaired by the use of such drug, will not be considered to have violated this policy. Employees shall be responsible for discussing with the prescribing medical practitioner whether any prescribed drug will or may affect the employee’s performance on the job. In the event an employee is advised that medication may affect performance, it is the employee’s responsibility to notify his or her supervisor of the circumstances prior to reporting to work.
G. CONVICTION UNDER CRIMINAL DRUG STATUS
Every employee, as a condition of continued employment, is required to immediately notify the company if they are convicted under a federal or state criminal drug statute, whether the act giving rise to such conviction occurred on or off Company premises.
H. COORDINATION WITH LAW ENFORCEMENT AGENCIES
The sale, use, purchase, transfer or possession of an illegal drug or drug paraphernalia is a violation of the law. The Company will report information concerning possession, distribution, or use of any illegal drugs to law enforcement officials and will turn over to the custody of law enforcement officials any such substances found during a search of an individual or property. The Company will cooperate fully in the prosecution and or conviction of any violation of the law.
Employee Supervision & Continuing Education Requirements
Employee Supervision
All employees will be supervised on an ongoing basis by respected personnel. All supervision will follow Medicare conditions of participation and time restraints that are set forth by the license you withhold.
Employee Continuing Education
All licensed employees must provide proof of ongoing continuing education that is specific to the license that they hold.
Inventory Checklist and Custody
Certify that I have been provided the below listed equipment (WHAT Ever Applies to you) in conjunction with my duties for UMS HomecareI understand that if I should not return the equipment upon my termination or resignation from UMS Homecare that I authorize the deduction of the value (listed below) from my paycheck. In addition, if lost or stolen, I am to report the incident immediately to UMS Homecare for replacement.
ITEM DESCRIPTION INVENTORY # VALUE
Stethoscope # $
BP Cuff # $
NS Gloves # $
Alcohol Prep Pads # $
Digital Thermometer # $
Carrying Bag # $
Temp Probe Covers # $
Sharps Collector # $
Other Items:
___________ #_____________ ____________
___________ #_____________ ____________
___________ #_____________ ____________
Professional Agreement Addendum
This AGREEMENT is between ______________________, hereafter referred to as “Professional’, and UMS Homecare, hereafter called “UMS Homecare”.
Under the Captain of the Ship Doctrine, UMS Homecare recognizes its limitation on certain issues required of a professional to remain in control over practices and procedures that require greater diligence than normally associated with an employer. If the Professional appears on the payroll and does not receive benefits; it is as an independent contractor and is not considered as an employer-employee relationship, particularly for those supervisory activities required by a licensed professional. This relationship does not transfer any or some of the professional’s obligations or liabilities. These liabilities remain with the professional and are covered by the professional’s practice insurance.
The duties and responsibilities of UMS Homecare are limited to the preparation of payroll and administration of employee benefits.
The Professional maintains his or her license as required by law, professional liability coverage and other responsibilities as found under state prime contract law. UMS Homecare is not involved in the day-to-day supervision or decision with regard to patient care or dentistry. This remains with the Professional as part of the Professional’s practice. The Professional fully indemnifies UMS Homecare against any and all liability and responsibility associated with his or her professional duties.
This Agreement is in effect at all times regardless of changes in employee status both as to the past and as to the future.
Agreement to Arbitrate Employment Claims
This Agreement to Arbitrate Employment Claims is made this the ______ day of ___________________, 20____, by and between UMS Homecare (the “Company”) and _________________________ (the “Employee”), upon the following terms and conditions:
1. Employee is employed by Company on an at-will basis. Employee is not subject to the terms of any individual written employment contract or collective bargaining agreement between Employee and the Company. This Agreement to Arbitrate Employment Claims agreement and the Conditions of Employment are the only written agreements between the Employee and the Company and except as expressly set forth herein, is intended to modify the employee-at-will relationship between the Employee and the Company to require arbitration of all employment disputes under the Federal Arbitration Act. Both parties waive the right to a judge or jury trial, except as provided in the Federal Arbitration Act.
2. In consideration of the continued employment relations between Employee and the Company, the Employee and the Company agree that any legal or equitable claims or disputes arising out of, or in connection with the Employee’s employment status, continued employment, terms and conditions of continued employment, employment-related disciplinary action, or the termination of employment, including related claims against other officers, employees or agents of the Company, will be settled by binding arbitration. Claims that are subject to arbitration include, without limitation, those arising under Title VII of the Civil Rights Act of 1964, the Age Discrimination and Employment Act, the Older Workers Benefit Protection Act, the Americans with Disabilities Act, the Employment Retirement Income Security Act, the Fair Labor Standards Act, or any federal law, or any civil rights, human rights, labor or employment law, rule, regulation or decision of any other state in the United States, or any other jurisdiction or country. This Agreement is intended to apply to claims involving Employee, Company and Company’s customers. The parties agree that Company’s customers are third party beneficiaries of this Agreement.
3. Except as modified by this Agreement, the arbitration will be conducted in accordance with the rules of the American Arbitration Association, and shall be conducted in the City of .
4. The arbitration procedure and results shall be equally binding on the Employee and the Company.
5. In the event that a mutually binding arbitrator cannot be selected by both parties, each party shall select an arbitrator and the two arbitrators shall select a third arbitrator and the matter shall be heard by a panel of the three arbitrators. Decisions will be by majority vote of the arbitrators. The arbitrator(s) shall have exclusive jurisdiction to interpret and enforce this agreement, including determination of arbitrability of any claim.
6. All costs and expenses of arbitration, except attorney’s fees and expenses, shall be borne equally by the Employee and the Company. Each party agrees to pay their own attorney’s fees and expenses and waives any claim against the other party.
7. Except as expressly modified herein, all damages available at law or in equity shall be available to the parties. The arbitrators shall issue a written opinion that summarizes the issue in dispute, describes the awards, and explains the reasons for the outcome.
8. The parties shall utilize the discovery procedures provided for in the rules of arbitration for employment disputes of the American Arbitration Association. The parties agree that the arbitrators shall govern any discovery disputes.
9. Either party may initiate the arbitration process by written demand with the arbitrator’s decision being final and binding on both parties. The arbitrator’s decision shall be entered in any court of competent jurisdiction.
Conditions of Employment
UMS Homecare is duly incorporated to provide employment contract services to patients. The following conditions of employment exist between
UMS Homecare and the employee named below.
(1) Employee acknowledges and understands that UMS Homecare will be responsible for payroll, withholding, and timely payment of all applicable employer and employee statutory employment taxes and insurance. These include social security, state unemployment, disability (where applicable) and workers’ compensation.
(2) It is understood that employment is at the mutual consent of the employee and the employer. Consequently, both employee and/or employer may terminate this employment relationship at any time, with or without cause or notice. Employment is expressly at will.
(3) As an employer UMS Homecare agrees to enter an employer relationship with the employee as outlined in the Employee Handbook, which the employee has received a copy.
This agreement embodies the entire employment agreement and understanding between UMS Homecare as the employer, and the Employee, and there are no representations, warranties, terms, covenants, or conditions made by either of the parties except as herein expressly contained.
Confidentiality Agreement
It is the responsibility of all Healthcare workforce members, including employees, medical staff, and office staff to preserve and protect confidential patient, employee and business information.
The Federal Health Insurance Portability Accountability Act (the “Privacy Rule”); govern the release of patient identifiable information by home health agencies and other health care providers. These laws establish protections to preserve the confidentiality of various medical and personal information and specify that such information may not be disclosed except as authorized by law or the patient or individual.
Confidential Patient Care Information includes: Any individually identifiable information in possession or derived from a provider of health care regarding a patient's medical history, mental, or physical condition or treatment, as well as the patients and/or their family members records, test results, conversations, research records and financial information. (Note: this information is defined in the Privacy Rule as “protected health information.”) Examples include, but are not limited to:
§ Physical medical and psychiatric records including paper, photo, video, diagnostic and therapeutic reports, laboratory and pathology samples;
§ Patient insurance and billing records;
§ Computer and department based computerized patient data;
§ Visual observation of patients receiving medical care or accessing services; and
§ Verbal information provided by or about a patient.
Confidential Employee and Business Information include, but are not limited to, the following:
§ Employee home telephone number and address;
§ Spouse or other relative names;
§ Social Security number or income tax withholding records;
§ Information related to evaluation of performance;
§ Other such information obtained from the Agency records which if disclosed, would constitute unwarranted invasion of privacy; or
§ Disclosure of Confidential business information that would cause harm to UMS Homecare
I understand and acknowledge that:
I shall respect and maintain the confidentiality of all discussions, deliberations, patient care records and any other information generated in connection with individual patient care, risk management and/or peer review activities.
It is my legal and ethical responsibility to protect the privacy, confidentiality and security of all medical records, proprietary information and other confidential information relating to UMS Homecare and its affiliates, including business, employment and medical information relating to our patients, members, employees and health care providers.
I shall only access or disseminate patient care information in the performance of my assigned duties and where required by or permitted by law, and in a manner which is consistent with officially adopted policies of UMS Homecare, or where no officially adopted policy exists, only with the express approval of my supervisor or designee. I shall make no voluntary disclosure of any discussion, deliberations, patient care records or any other patient care, peer review or risk management information, except to persons authorized to receive it in the conduct of UMS Homecare affairs.
UMS Homecare Administration performs audits and reviews patient records in order to identify inappropriate access.
My user ID is recorded when I access electronic records and that I am the only one authorized to use my user ID. I will only access the minimum necessary information to satisfy my job role or the need of the request.
I agree to discuss confidential information only in the work place and only for job related purposes and to not discuss such information outside of the work place or within hearing of other people who do not have a need to know about the information.
I understand that any and all references to HIV testing, such as any clinical test or laboratory test used to identify HIV, a component of HIV, or antibodies or antigens to HIV, are specifically protected under law and unauthorized release of confidential information may make me subject to legal and/or disciplinary action.
My obligation to safeguard patient confidentiality continues after my termination of employment with the UMS Homecare
I hereby acknowledge that I have read and understand the foregoing information and that my signature below signifies my agreement to comply with the above terms. In the event of a breach or threatened breach of the Confidentiality Agreement, I acknowledge that the UMS Homecare may, as applicable and as it deems appropriate, pursue disciplinary action up to and including my termination from the UMS Homecare.
HIPAA Training
Introduction: In 1996, Congress enacted the Health Insurance Portability and Accountability Act, also known as HIPAA. Among the primary purposes of HIPAA are (1) to protect people from losing their health insurance if they change jobs or have pre-existing health conditions, (2) to reduce the costs and administrative burdens of healthcare by creating standard electronic formats for many administrative transactions that are currently carried out on paper, and (3) to develop standards and requirements to protect the privacy and security of confidential healthcare information.
Finish Mandatory HIPAA Training - Click Here
Hepatitis B Vaccine Information - Click Here
Hepatitis B Declination Or Acceptance Statement
The following statement of declination of hepatitis B vaccination must be signed by an employee who chooses not to accept the vaccine. The statement can only be signed by the employee following appropriate training regarding hepatitis B, hepatitis B vaccination, the efficacy, safety, method of administration, and benefits of vaccination, and that the vaccine and vaccination are provided free of charge to the employee. The statement is not a waiver; employees can request and receive the hepatitis B vaccination at a later date if they remain occupationally at risk for hepatitis B.
Declination Statement
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to me; however, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine I continue to be at risk of acquiring hepatitis B, a serious disease. If, in the future, I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.
I Decline to taking Vaccine
I Accept to taking Vaccine
Employee Signature:_____________________________ Date:____________________
Acknowledgement of attending Orientation Website/Receiving Handout
I received education on the Policies & Procedures/forms/topics in a logical manner in this Orientation Process Website/Handouts and
I, ____________________________ understand and agree to abide by the policies and procedures set forth by UMS Homecare
(please print)
Employee Signature __________________________________ Date________________
Administrative Signature: _____________________________ Date: _______________
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