Policy Manual sample

MDT Home Health Care Agency, Inc. ADMINISTRATOR STATEMENT OF QUALIFICATIONS COMPLIANCE* Administrator Name: ________________________________________ As Administrator I began employment with the Agency prior to January 13, 2018, and comply with one of the following requirements: (i) Licensed physician; Licence: _____________________ (ii) Registered Nurse; License: ______________________ (iii) Has training and experience in health service administration and at least 1 year of supervisory administrative experience in home health care or a related health care program. Administrator signature: _______________________________ Date: ___________________________ * Attach to Administrator Job Description Home Health Agency Job Descriptions I-9