Policy Manual sample

MDT Home Health Care Agency, Inc. h. Infection Control Form i. Job Description j. Statement of Commitment Form k. Confidentiality Statement Form I. Probationary Period Acknowledgment Form (If Applicable) m. Orientation Form n. W-9 (Contract Employees) and W-4 (Direct Employees) Form o. Emergency Notification Form (Next of kin or guardian) p. License Verification (RN/LPN/PT/OT/ST/MSW/CNA) q. Professional Liability Insurance (RN/LPN/PT/OT/ST/CNA) (copy) r. Automobile Liability Insurance (copy) s.Two (2) References Form t. Evaluation (90 days) then annually thereafter u. Confidential Envelope (Inside Staff file as State regulation) 1. Background check results 2. Health Questionnaire 3. Physical Examination/Medical Certificate v. Professional License (RN/LPN/PT/OT/ST/MSW/CNA) w. Certifications for CNA (if applicable) x. Home Health Aide 75 hours certification (if applicable) y. Original four (4) hours HIV (1 life time training) z. Domestic Violence Update (current biannual) aa. HIV Update (if applicable, 1 lifetime training) bb. OSHA Update (current/biannual) cc. CPR Card active. dd. Home Health Aide 12 hours additional yearly in-services ee. Licensure or Registration (If Applicable). ff. Date of Employment. Home Health Agency. - - Personnel/Operations Policies B-13