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• Personal History

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  Behavioral HealthLabPhysician / NP / PAPharmacyRadiologyPhoenix NursingRespiratory TherapistSurgicalTravel NursingTherapyTucson Nursing
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• Specialty*
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• Address*
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• Professional History

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• TERMS OF ACCEPTANCE AND SIGNATURE
  I, the applicant for this form, warrant the truthfulness of the information provided in this application.
• Accept*
  • I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
• Date

• Substance Abuse Policy

• 1.0 POLICY:

  In the later part of 1988, the federal government passed into law a requirement that all government contractors establish guidelines which specifically identify a company's posture regarding the use, possession, and sale of drugs and alcohol by its employees. Concentric is fully committed to the idea of keeping drugs/alcohol out of the workplace and has established the following policy:

  It is the policy of CONCENTRIC to prohibit In the workplace the unlawful possession, use, dispensation, distribution or manufacture of controlled substances, illegal drugs and alcohol. Violation of this policy will result in disciplinary action up to, and including, termination of employment. Depending upon the circumstances, other action, including notification of appropriate law enforcement agencies, may be taken against any violator of this policy. In accordance with the Drug-Free Workplace Act of 1989, as a condition of employment, staff members must comply with this policy and notify management within five (5) days of conviction for any criminal drug violation occurring in the workplace. Failure to do so will result in immediate termination of employment. Any staff member arrested in connection with a criminal drug violation occurring in the workplace will be placed on personal leave of absence without pay and subject to termination of employment pending the outcome of any legal investigation and conviction.

  2.0 PROCEDURE:

  At present time, we require mandatory drug/alcohol testing of all employees, and do conduct random tests when the safety of employees or clients may be in question. Such tests may be deemed necessary based on observed inconsistent or erratic behavior that constitutes a health or safety hazard to other employees and/or clients,or the personal safety of the employee displaying the behavior.

  2.1 Since, the Drug-Free Workplace Act requires that companies be able to document the notification and receipt of its policy by each staff member, we are asking that you sign the statement at the bottom of this policy, detach and return it to our office for inclusion in your personnel file. In this way we can fully document our compliance in the notification process.

  2.2 We strongly support the intent and purpose of the Drug-Free Workplace Act and encourage all staff members to fully comply with the provision of the program. It is only with everyone's support that we can successfully implement this policy.

• Release and Authorization*
  • I have received and reviewed a copy of the Concentric policy on Substance Abuse, have read and understood the provisions of the policy, and will comply with all aspects of the policy.
• Employee Initials
  
• Date

• Background Release Form

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  Applicant Information*
  First Name Full Middle Name Last
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• Other Names (Maiden Name, A’s)
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• Current Address
  
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• Duration at Current Address: Years*
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• Duration at Current Address: Months*
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• Previous Address*
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• Duration at Previous Address: Years*
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• Duration at Previous Address: Months*
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• Mother's Name*
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• Graduated?*
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• If Yes, Date Diploma Received
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• Degree Received?
• In connection with this request, I authorize all Corporations, Companies, Former Employers, Credit Agencies, Educational Institution, and Law Enforcement Agencies, City, State, County and Federal Courts, Military Services and persons to release information they may have about me to the person or company with which this form has been filed, or their agent, Criminal 411 and releases all Parties involved from any liability and responsibility for doing so. I also authorize the procurement or an investigative consumer report and understand that it may contain information about my background, personal reputation, mode of living, character, driving record history, credit report history or social security number search for residency. Further I authorize the investigative agency to contact me for further information and or clarification of any information obtained. This authorization, in original or copy form, shall be valid for this and any future reports or updates that may be requested. A copy of the investigative report may be obtained by written request within 30 days from signature date below.
• Release and Authorization*
  • I have read and understand this notice.
• TERMS OF ACCEPTANCE AND SIGNATURE
  I, the applicant for this form, warrant the truthfulness of the information provided in this application.
• Accept*
  • I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
• Date

• Equal Employment Opportunity & Workforce Diversity

• The promotion of equal opportunity in the workplace enhances basic human dignity and the welfare of the society upon which the success of our business depends. Concentric affirmatively ensures that all employment decisions made at Concentric are based upon ability, experience and achievement of the individuals, without regard to race, color, religion, gender, sexual orientation, national or ethnic origin, age, mental or physical disability, veteran status, or other factors prohibited by applicable law. The policy extends to all aspects of recruiting, hiring, promotion, selection for training, compensation, job assignment, leaves of absence, layoff, termination and the maintenance of non-segregated facilities. The commitment of Concentric to these policies is reaffirmed each year to underscore their importance as an integral part of our structure.

  Concentric’s policies regarding equal employment opportunity and diversity in the workplace have been and will continue to be based upon principles of respect for each individual. The Affirmative Action Program recognizes the industry’s changing mosaic of people, customers, strategies and environment and seeks to enhance and enrich our workforce by increasing employment opportunities for individuals, including those with disabilities,special disabled veterans and veterans of the Vietnam Era.

• Release and Authorization*
  • I have read and acknowledged the above policy related to Equal Employment Opportunity & Workforce Diversity.
• Employee Initials
  
• Date

• Employee Ethics Agreement

• Purpose: This agreement is to insure that Concentric Healthcare Staffing’s medical personnel maintain the highest level of ethics while on assignment with any Concentric Healthcare Staffing’s clients or facilities.

  I, , here by state that under no circumstances, will I engage in, be involved in, or have knowledge of any unethical or immoral practices are as follows:

  • Breaking the laws of the State of Arizona or of the United States of America.
  • Borrowing or accepting any gifts, money, or possessions of value.
  • Use of improper or unprofessional language.
  • Being involved in any sexual acts while on assignment.
  • Improper use of facility or client vehicles.
  • Physical or mental abuse or mistreatment of any kind.
  • Diversion of medication meant for facility or client.
  • Use of drugs (prescribed or not prescribed) or alcohol while on assignment.
  • The use of physical or verbal threats of violence.

  Any violation of these ethical or immoral boundaries can result in disciplinary action, termination, or legal action against the above mentioned Concentric personnel.

• Release and Authorization*
  • I do agree to the above statement and will abide by these rules.
• Employee Initials
  
• Date

• Drug Free Workplace Consent to Test and Policy Acknowledgement Form

• I, , have received, read and understand the Concentric Healthcare Staff Drug Free Workplace Policy. I acknowledge that I will be required to complete a pre-employment drug test. I consent to the drug test and understand that I am expected to comply with the testing requirements to be considered for employment. Furthermore, I understand that I may be subject to other types of drug and/or alcohol testing as outlined in this policy.

• Release and Authorization*
  • By my signature below, I acknowledge, understand, accept and agree to comply with the of the Drug Free Workplace policy.
• Employee Initials
  
• Date

• Sentinel Events and Infection Prevention

• POLICY

  The organization works to prevent untoward/sentinel events. An untoward/sentinel event is defined as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof that is not related to the natural course of a patient's illness or underlying condition. Serious injury specifically includes loss of limb or function.

  The phrase "or the risk thereof includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Sentinel events are occurrences that affect the recipient of care and signal the need for immediate investigation and response. Health care related infections will be evaluated as a sentinel event if death or loss of function is determined to be related to the acquired infection.

  PURPOSE

  • To respond to events that represent a threat to the safety of CHS's patients or employees and that require immediate response by the management team.
  • To investigate the cause of the event and implement a plan for performance improvement.
  • To focus the attention of the agency on understanding the causes that underlies the event, and changing systems and processes to reduce the probability of such an event in the future.
  • To increase the general knowledge about sentinel events, causes and strategies for prevention.
  • To respond appropriately to ALL untoward/sentinel events by reporting the event, completing a timely, thorough, root cause analysis focusing on systems and processes, developing an action plan, implementing changes and monitoring effectiveness of changes.
  • To manage as a sentinel event all identified cases of unanticipated death or manor permanent loss of function associated with a health care associated infection.

  PROCEDURES

  1. Staff is educated about sentinel events.
  2. The Director and leadership team evaluates outcomes of incidents and identifies those that are defined as sentinel events and near misses.
  3. The extent of the investigation may vary based on leadership team review.
  4. Sentinel events are either reportable or not reportable to the Joint Commission and/or when the organization is accredited. At a minimum, those listed in the examples above are reviewable and reportable per JCAMO requirements.
  5. CHS will implement an investigation within 24 hours of notification of the sentinel event.
     1. A distinction is made between an adverse outcome that is related to the natural course of the patient's illness or underlying condition (not reportable) and a death or major permanent loss of function that is associated with the treatment, or lack of treatment,of that condition (voluntarily reportable).
     2. Major permanent loss of function means sensory, motor, physiological, or intellectual impairment not present or admission requiring continued treatment or life-style change. When major permanent loss of function cannot be immediately determined reporting is not expected until either the patient is discharged with continued major loss of function, or two weeks have elapsed with persistent major loss of function,whichever occurs first.
     3. The determination of rape is to be consistent with applicable law and regulation. Reporting of an allegation of rape is not expected. The five-day time frame for voluntarily reporting begins when a determination is made that a rape has occurred. Reporting of a rape is not expected where such reporting is prohibited by law
  6. A reportable untoward/sentinel event would be reviewed by administration to determine the options for reporting and decide which option the organization will use. JCAHO directives would be used to determine the most current options.
  7. Both reportable and non-reportable sentinel events, sometimes referred to as "near misses," are intensely investigated using principles of root cause analysis and developing an action plan.
  8. CHS will prepare a thorough and credible root cause analysis and action plan within 45 calendar days of the event or becoming aware of the event, when the event is subject to review by the JCAHO Sentinel Event Policy.
  9. Results of analysis are used to guide system and/or process changes to prevent the recurrence of it or to eliminate further near miss situations. Improvements arc implemented to reduce risk and actions are taken to monitor the effectiveness of the improvements.
  10. The Administrator or designee monitors Untoward/Sentinel Event Alerts from JCAHO and other pertinent literature to identify knowledge-based information that could reduce the chance of sentinel events.
      1. CHS will do everything possible to provide follow-up care/services to ensure the best possible outcomes for involved parties.
      2. Any immediate regulatory reporting requirements, such as Occupational Safety and Health Administration, is notified in the event of employee death.
      3. Obtain, sequester, or preserve appropriate evidence (for example, photographs of the location of the injury or equipment that malfunctioned).
      4. If a root-cause analysis needs further discipline representatives. the*, will ko „Jdod. cue will determine the root cause of the event, including analysis of all processes and systems related to its occurrence.
      5. Risk reduction strategies will be formed within a week of the analysis. Potential improvements in processes or systems that would tend to decrease the likelihood of such events occurring in the future will be determined. Examples may include a change in communication, forms, training, equipment, policies and procedures. If no potential improvements exist, the analysis will indicate that no such opportunities exist. CMS will track implementation of the risk reduction strategies for the Agency
      6. Results of the above will be reported to the Executive Management Team as needed.
  11. ROOT CAUSE ANALYSIS:
      1. Will be acceptable to Medicare and Joint Commission if the analysis:
         • Focuses primarily on systems and processes and not individual performances.
         • Progresses from special causes in clinical processes to common causes in organizational processes.
         • Repeatedly digs deeper, asking why.
         • Identifies changes that could be made in systems or processes that would reduce risk of future events.
      2. Will be thorough if the analysis includes:
         • Determination of human and other factors most directly related to the sentinel event and the processes and systems related to its occurrence.
         • Analysis of underlying systems or processes.
         • Inquiry into all areas appropriate to the type of event.
         • Identification of risk points and their contribution to type of event.
         • Determination of potential improvement in processes to decrease risk.
      3. Will be credible if analysis:
         • Included participation by the leadership of the organization and individuals most closely involved in the systems and/or processes under review.
         • Is internally consistent and does not contradict itself.
         • Provides explanation for all findings of, "not applicable" or "no problem."
         • Includes consideration of relevant literature.
      4. An ACTION PLAN will be acceptable if it:
         • Identifies change that can be implemented to reduce risk or an explanation for not undertaking such changes.
         • Identifies, in appropriate situations, who is responsible for implementation, when implementation will be done, and how it will be evaluated.
• By initialing below I acknowledge and agree to follow these procedures. I also understand that to review these procedures I can find a copy located in the CHS office, ask for a copy during time of signature or request a copy to be sent to me.
• Release and Authorization*
  • I have read and understand Concentric Healthcare’s Policy and Procedure document.
• Employee Initials
  
• Date

• Infection Prevention/Control Plan

• POLICY

  The agency will observe the recommended precautions for home care as identified by the Centers for Disease Control and Prevention (CDC). The precautions cover those clients with documented or suspected infection with highly transmissible or epidemiologically important pathogens that require additional precautions to prevent transmission.

  The agency will have an infection prevention and control component to the Infection program. This program will evaluate those client populations to be at risk and implement processes as needed. Concerning the prevention of the transmission of the Human Immunodeficiency Virus and Hepatitis B virus, documentation will be maintained on infections that the client acquires while receiving services from the agency.

  PURPOSE

  To ensure employee and client safety

  To ensure the prevention of the spread of infectious and communicable disease

  To reduce the risk of transmission of microbes from both recognized and unrecognized sources of infection

  To address the influx or risk of an influx of infectious patients

  PROCEDURE

  1. The agency is licensed to provide services other than personal assistance services.
     1. Documentation will include the date that the infection was detected, the client name, primary diagnosis, signs and symptoms, type of infection, pathogens identified, and treatment disclosed by the client. The records will be kept in the PI department.
  2. In 1995, the Centers for Disease Control and Prevention (CDC) issued new isolation guidelines called Standard Precautions. Standard precautions apply to:
     1. Blood
     2. All body fluids regardless of whether they contain blood, except sweat
     3. Non-intact skin
     4. Mucous membranes

  Standard precautions contain two tiers of approach. The first tier uses major features of standard precautions and the principles of body substance isolation.

  STANDARD PRECAUTIONS -TIER ONE

  1. Standard precautions apply to blood, all body fluids, secretions, excretions, non-intact skin, and mucous membranes. All are to be treated as a potential source of infection regardless of whether the client has a communicable disease.
  2. Hands are washed if contaminated with blood or body fluid, immediately after gloves are removed, between client contacts, and when indicated to prevent transfer of microorganisms between other clients or the environment.
  3. Gloves are worn when touching blood, body fluids, secretions, excretions, non-intact skin, mucous membranes, or contaminated items.
  4. Masks, eye protection, or face shields are worn if client-care activities may generate splashes or sprays of blood or body fluid.
  5. Gowns are worn if clothing is likely to be soiled from blood or body fluid. Wash hands after removing gown.
  6. Equipment used for client care is properly cleaned and reprocessed. Single-use items are discarded.
  7. Contaminated linen is placed in a leak proof bag and carefully handled to prevent skin and mucous membrane exposure.
  8. All sharp instruments and needles are discarded in a puncture-resistant container. The CDC recommends needles be disposed of without capping or that a mechanical device be used for recapping.
  9. When possible devices, which offer an alternative to needles, will be used. Examples of such devices include stopcocks (on-off switch) needle-protected systems or needleless systems that can be used in place of open needles to connect intravenous lines. Other devices that are integral to the syringe, such as self-sheathing needles, allow both hands to remain behind the needles.

  DISEASE-SPECIFIC STANDARD PRECAUTIONS -TIER TWO

  This approach provides isolation guidelines with new transmission categories based on airborne, droplet, and contact transmission of infectious disease.

  1. Airborne Precautions: Use mask or respiratory protection (see CDC TB Guidelines)
  2. Droplet Precautions: Use mask. Isolate clients from those at risk of infection.
  3. Contact Precautions: Use gowns, gloves, and masks as appropriate.

  PROCEDURE

  The agency has a process in place to identify the need for infection prevention and control by evaluating the following:

  • Client populations to be served
  • Clients at high risk for infection
  • Common diagnosis of clients served
  • Types of care provided by the agency
  • Risks of infectious transmission
  • Types of medical devices, equipment or supplies used in client care and provided by the agency
  • Types and amount of medical waste generated
  • Risks of occupational exposure
  • Clients who are identified as high-risk groups include those experiencing immunosuppression. This group includes those with HIV-related illnesses, bone marrow transplantation, hemotologic malignancy, cancer, drug-induced suppression, radiation therapy, and the very young or very old. Other groups designated at risk are individuals with trauma, burns, surgical wounds or malnutrition.

  Types of care that may place clients at risk for infection:

  • Airway suctioning
  • Blood specimen collection (venous puncture)
  • Burn Care
  • Cardiopulmonary resuscitation (CPR)
  • Dialysis (hemodialysis or peritoneal)
  • Enteral tube feedings and tube replacements
  • Implantable port access
  • IV medication or solution administration
  • Oxygen administration
  • Urethral or suprapubic catheterization
  • Venous access device insertion and site care
  • Wound and ostomy care

  Medical devices, equipment, and supplies that clients may use or that agencies may provide fall into three categories -noncritical, semicritical, or critical:

  • Noncritical items come into contact with intact skin, but no mucus membranes or skin that is non-intact.
  • Semicritical items come into contact with the mucus membranes or skin that is non-intact.
  • Critical items enter directly into the bloodstream or into other normally sterile areas of the body.

  These three categories were developed based on the potential risk of infection identified in their use as well as the methods required for cleaning, disinfection, and sterilization.

  METHICILLIN RESISTANT STAPHYLOCOCCUS AUREAUS (MRSA)

  Care of client with identified infection

  • MRSA is a strain of Staphylococcus Aureaus that is resistant to most antibiotics. Vancomycin is the most reliable antibiotic for treatment.
  • Clients who are colonized with MRSA can act as reservoirs for transmission to family, employees and other health care personnel.
  • Can be transmitted via unwashed hands, contaminated equipment, or clothing.
  • Homecare staff who touch their nose with unwashed hands are at risk for colonization of MRSA.
  • MRSA can live up to 14 days in the environment.

  Policy:

  • Standard precautions will be used with all clients.
  • Hand washing must be done before and after all client contact.
  • Personal protective equipment including gloves, mask or gown will be used when appropriate for care.
  • The client and their family will be made aware to wash their clothes separately and ensure good hand washing techniques.
  • ALL involved staff will be informed of the diagnosis and the care plan will be tailored accordingly.
• By initialing below I acknowledge and agree to follow these standards and procedures. I also understand that to review this plan I can find a copy located in the CHS office, ask for a copy during time of signature or request a copy to be sent to me.
• Release and Authorization*
  • I have read and understand the Infection Prevention/Control Plan.
• Employee Initials
  
• Date

• Hand Washing Guidelines

• Since person-to-person spread can play a significant role in the spread of some enteric pathogens, hand hygiene is a critical element of any outbreak prevention and control strategy. Concentric Healthcare’s standards for hand washing are to prevent infection and the spread of infection. All of our medical professionals must wash their hands frequently to prevent the propagation of the illness.

  Hand must be washed frequently and if contaminated with blood or bodily fluid, immediately after gloves are removed, between client contacts, and when indicated to prevent transfer of microorganisms between other clients or environments. Hand washing must be done before and after all client contact.

  Steps to proper hand washing...

  1. Hands should be washed using soap and warm, running water.
  2. Hands should be rubbed vigorously during washing for at least 20 seconds with special attention paid to the backs of the hands, wrists, between the fingers and under the fingernails.
  3. Hands should be rinse well while leaving the water running.
  4. With the water running, hands should be dried with a single-use towel.
  5. Turn off the water using a paper towel, covering washed hands to prevent re-contamination.

  Hands should be washed after the following activities:

  • After touching bare human body parts other than clean hands and clean, exposed portions of arms.
  • After using the toilet.
  • After coughing, sneezing, using a handkerchief or disposable tissue, using tobacco, eating or drinking.
  • After handling soiled equipment or utensils.
  • After food preparation, as often as necessary to remove soil and contamination and to prevent cross-contamination when changing tasks.
  • After switching between working with raw food and working with ready-to-eat food.
  • After engaging in other activities that contaminate the hands.
• By initialing below I acknowledge and agree to follow these guidelines and procedures. I also understand that to review these guidelines I can find a copy located in the CHS office, ask for a copy during time of signature or request a copy to be sent to me.
• Release and Authorization*
  • I have read and understand Hand washing Guidelines.
• Employee Initials
  
• Date

• A Patient’s Bill of Rights

• Introduction

  Effective health care requires collaboration between patients and physicians and other health care professionals. Open and honest communication, respect for personal and professional values, and sensitivity to differences are integral to optimal patient care. As the setting for the provision of health services, hospitals must provide a foundation for understanding and respecting the rights and responsibilities of patients, their families, physicians, and other caregivers. Hospitals must ensure a health care ethic that respects the role of patients in decision making about treatment choices and other aspects of their care. Hospitals must be sensitive to cultural, racial, linguistic, religious, age, gender, and other differences as well as the needs of persons with disabilities.

  The American Hospital Association presents A Patient's Bill of Rights with the expectation that it will contribute to more effective patient care and be supported by the hospital on behalf of the institution, its medical staff, employees, and patients. The American Hospital Association encourages health care institutions to tailor this bill of rights to their patient community by translating and/or simplifying the language of this bill of rights as may be necessary to ensure that patients and their families understand their rights and responsibilities.

  Bill of Rights

  These rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.

  1. The patient has the right to considerate and respectful care.
  2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.
     
     Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.
     
     Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as when those involved are students, residents, or other trainees. The patient also has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known.
  3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfers to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.
  4. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy.
     
     Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an advance directive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive.
  5. The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient's privacy
  6. The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.
  7. The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.
  8. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.
  9. The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient's treatment and care.
  10. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.
  11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.
  12. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital's charges for services and available payment methods.

  The collaborative nature of health care requires that patients, or their families/surrogates, participate in their care. The effectiveness of care and patient satisfaction with the course of treatment depends, in part, on the patient fulfilling certain responsibilities. Patients are responsible for providing information about past illnesses, hospitalizations, medications, and other matters related to health status. To participate effectively in decision making, patients must be encouraged to take responsibility for requesting additional information or clarification about their health status or treatment when they do not fully understand information and instructions. Patients are also responsible for ensuring that the health care institution has a copy of their written advance directive if they have one. Patients are responsible for informing their physicians and other caregivers if they anticipate problems in following prescribed treatment.

  Patients should also be aware of the hospital's obligation to be reasonably efficient and equitable in providing care to other patients and the community. The hospital's rules and regulations are designed to help the hospital meet this obligation. Patients and their families are responsible for making reasonable accommodations to the needs of the hospital, other patients, medical staff, and hospital employees. Patients are responsible for providing necessary information for insurance claims and for working with the hospital to make payment arrangements, when necessary.

  A person's health depends on much more than health care services. Patients are responsible for recognizing the impact of their life-style on their personal health.

  Conclusion

  Hospitals have many functions to perform, including the enhancement of health status, health promotion, and the prevention and treatment of injury and disease; the immediate and ongoing care and rehabilitation of patients; the education of health professionals, patients, and the community; and research. All these activities must be conducted with an overriding concern for the values and dignity of patients.

• Release and Authorization*
  • I acknowledge that I have read and understand the above document entitled “A Patient’s Bill of Rights”.
• Employee Initials
  
• Date

• Hepatitis B Decline

• I have been given the opportunity to be vaccinated with the Hepatitis B vaccine. However, I decline the Hepatitis B vaccination at this time. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination at no charge to me.
• Release and Authorization*
  • I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the Hepatitis B virus (HBV) infection.
• Employee Initials
  
• Date

• Annual Fit Mask Questionnaire

• Employee Name
  
• Mask Size*
  Mask Type: 3M
  • Small
  • Regular
  • Large
  • Hood
• Has your body weight changed more than 10% in the past year?*
  • Yes
  • No
• Have you had major dental work done in the past year?*
  • Yes
  • No
• Have you had facial changes in the past year?*
  • Yes
  • No
• Have you had any changes in your medical condition in the past year?*
  • Yes
  • No
• Have you had any problems that would prevent you from wearing the mask?*
  • Yes
  • No
• Have you had any problems wearing the mask?*
  • Yes
  • No
• If the answer to any of the above questions is YES, please specify*
• Release and Authorization*
  • I certify that the answers to the above questions are true.
• Employee Initials
  
• Date

• Employment Contract

• Professionalism:

  Concentric Healthcare Solutions has a reputation for hiring high quality professionals. It is imperative that you maintain a high level of respect and integrity in all situations you encounter. If you have any problems that arise while working and feel that you need our office to act as a liaison please do not hesitate to contact the 24 hour staffing line.

  Personal Hygiene & Appearance:

  Please always show up to work in your proper uniform. All hospitals and nursing homes require scrubs. Most of the behavioral health clients require business casual attire such as khakis and polo shirts. Inappropriate attire includes but is not limited to: open toe shoes, visible tattoos and piercings, torn or ripped clothing, excessive jewelry and T-shirts. Remember, in addition to representing Concentric Healthcare you are representing yourself and a professional appearance is required. If you have any questions on what the dress code is with a particular client, please ask a Concentric repetitive at the time of scheduling.

  Availability/Shift Acceptance:

  Concentric Healthcare offers you the flexibility to create your own schedule. In return, we hold you accountable for the availability you give us and all shifts that you schedule. Please be prompt in calling Concentric with your availability, this will help us meet the scheduling needs. Obviously, we welcome you to pick up last minutes shifts. However, it behooves you to notify Concentric of your schedule as far in advance as possible. After you are booked, contact Concentric Healthcare if you need to make any changes to your schedule. Communication is a key factor in ensuring that you work the desired amount of hours.

  Confirmations:

  Almost all shifts scheduled with Concentric Healthcare require confirmation 2 hours prior to your shift. It is your responsibility to contact Concentric to confirm your shift 2 hours in advance. At this time, we will either tell you to go to work if you have been confirmed or offer you additional shifts if you have been cancelled. If you need clarification on whether or not you are booked for a confirmed shift please ask your scheduler.

  Shift Specifics:

  Before you go out to your shift, make sure you are prepared with the directions and phone number. You are responsible for bringing the following items to every shift: time sheet, ID, Concentric badge, license (as applies) and credentials (as applies). To get the proper directions you may go to www.mapquest.com or other directional web-sites. If you do not have internet access, please ask your scheduler.

  Client Interaction:

  Concentric Healthcare has procedures set-up to ensure a smooth scheduling process. Please only schedule shifts through your Concentric schedulers. If a client wants to book you for a shift contact the staffing office immediately so that it can be documented and entered into our system. Failure to follow implemented processes can result in the inability to pay you properly.

  Overtime:

  All overtime needs to be approved prior to working your shift. It is extremely important that you notify the office if you work additional hours because the hours you work in the beginning of the week will affect the amount of overtime that needs to be approved. If you book a shift with a client and fail to notify Concentric Healthcare of the shift and this lack of communication results in unapproved overtime you will not be paid time and half for any OT worked. It is always helpful to contact a Concentric scheduler when you notice that you will be going into overtime.

  Attendance:

  Please refrain from calling off unless there is an EMERGENCY! If you are unable to work a shift that you have accepted, we ask that you give a minimum of 24 hours notice.

  Call Off/Late Show/No-Show Policies:

  • No-Call, No-Show: Unless a valid, documented (ie. doctor’s note) reason is given employee will be subject to disciplinary action and possible termination without the ability to reapply for 6 months. Due to the fact that many of our contracted facilities charge Concentric Healthcare for the full shift if an employee no-shows, Concentric Healthcare reserves the right to deduct the full amount charged from your pay.
  • If employee calls off with less than four (4) hours notice on more than three (3) occasions, employee will be terminated without the ability to reapply for 6 months.
  • If employee calls off without at least two (2) hours notice on more than one (1) occasion, employee will be terminated without the ability to reapply for 6 months. As stated in many of our facility contracts, Concentric Healthcare will be charged a cancellation fee when our employee calls off with less than 2 hours notice. Therefore, Concentric Healthcare reserves the right to deduct the full amount charged from your pay.

  Time Sheets:

  Please follow the detailed instructions outlined on the Timesheet/Payroll document located in your employee packet when filling out your time sheets. Remember to be accurate and turn them in on time, so not to detour or delay your paycheck. Timesheets that are faxed without an authorized signature will not be paid until you re-fax onethat has been signed. All timecards must be signed and faxed to our office by 10am every Monday. Many of our clients require that you log in on their Sign-In Book rather that utilizing a Time Card. Please check with your Concentric scheduler for details on whether or not you need to use a Time Card or a Sign-In sheet located on site.

• Release and Authorization*
  • I have read and understand all of the policies and procedures listed in Concentric Healthcare’s Employment Contract.
• Employee Initials
  
• Date

• Employment Agreement

• Concentric Healthcare Solutions, (“Concentric”), conditionally offers to employ “name”
  
• On "date"

• 1. Ratification - You understand and acknowledge that this offer of temporary employment with Concentric is subject to final approval by the Client and that you shall not be entitled to any wages or employment unless actually hired by Concentric to work the specific assignment for the Client pursuant to this agreement. You also understand that this agreement does not go into effect until you actually work on said specific assignment. You acknowledge and understand that your employment with Concentric is “at will”, with no certain term being offered or promised, and that you or Concentric may terminate your employment, with or without cause, at any time.You agree that by reporting or remaining at work after initialing this agreement that you have ratified the same. In addition, you represent and warrant to Concentric that your employment with Concentric will not violate the terms or conditions of any other agreement to which you are a party.

  2. Reporting of Hours - You agree to submit completed time record to the Concentric office by 10:00 am on Monday of each week, written in ink and approved and verified by a Client supervisor, indicating the number of hours worked. Failure to submit completed time records before 10:00 am on Monday may result in the delay of payment of wages. You acknowledge that Concentric needs completed time records to obtain payment from the Client, and therefore you will accurately complete, sign and assist Concentric in gaining Client’s approval and verification of your time records each week. You understand and agree that in the absence of complete and accurate time records, Concentric cannot accurately determine the number of hours worked and your corresponding wages. Consequently, you also understand and agree that your paycheck will not be released unless your Client approved and verified time records have reached Concentric’s office. You acknowledge Concentric’s policy and practice of mandating recordation of all hours worked. Concentric does not permit “off the clock” work or any similar practice of not recording hours worked. Any requested by the Client or other third party not to record all hours worked must be reported in writing by you to Concentric.

  3. Restrictive Covenant - In consideration of the terms of employment and the efforts and costs incurred by Concentric, you agree you shall not solicit Client or engage in a like similar profession or occupation at Client’s facility or any other facility at which you are directed to or actually perform services under this agreement, either directly or indirectly, for a period of one hundred eighty (180) days following the termination of your employment under the terms of this agreement, unless specific written authorization has been obtained from Concentric. You agree that any violation of this provision will result in you paying to Concentric an amount equal to three hundred twenty (320) hours at the hourly bill rate of assignment.

  4. Confidentiality - You agree not to disclose to anyone, either during or after your employment with Concentric any confidential or proprietary information of any kind obtained by you as a result of your employment without the written consent of executive officers of both the Client and Concentric, and you further agree that on leaving the employment of Concentric, you will not take with you, without permission of executive officers of both the Client and Concentric, any blueprint, drawing, or other reproduction, property or material of any kind. You also agree to execute any forms or documents required by the Client with respect to the foregoing.

  YOU FURTHER AGREE NOT TO DISCUSS THE COMPENSATION SATED IN THIS AGREEMENT, OR THE COMPENSATION PAID TO YOU BY CONCENTRIC PURSUANT TO ANY PRIOR EMPLOYMENT AGREEMENT, IN ANY MANNER, WITH THE CLIENT, THE CLIENT’S EMPLOYEES OR ANY CONTRACT EMPLOYEE OF THE CLIENT

  5. Ownership of Work Product - You agree that you will disclose and assign full and absolute right, title, and interest to the Client of any and all inventions, improvements, or discoveries made by you of any kind or naturewhatsoever during the tenure of this agreement, and you will execute and all documents and instruments necessary to transfer the full and complete title of any such inventions, improvements, and discoveries to the Client, and shall assist in any manner possible in obtaining patent letters in the name of said Client covering them. You also agree to execute any forms or documents required by Client with respect to the foregoing.

  6. Indemnification - You agree to indemnify and save harmless Concentric from and all liability, loss, damage or expense which may be caused by your negligence or failure to perform your duty under the terms of this agreement.

  7. Termination - You shall give a minimum of ten (10) days notice should you decide to terminate your position with Concentric. You understand that the length of assignment is subject to the discretion and needs of the Client and, therefore, a five day notice from Concentric may not be possible and Concentric is not required to provide such notice. Upon termination, and to the extent permitted by applicable law, you acknowledge and agree that any amounts owed by you to Concentric will be deducted from any remaining wages owed to you and refunded by Concentric.

  8. Staff Shift-No-Shows - If a Concentric employee does not report for a scheduled shift, and Concentric employee has failed to give any advance notice to Concentric, then Concentric may have fees, penalties, lost revenue or other damages deducted from Concentric employee’s check.

  9. Notification of Completion of Assignment - You agree that upon completion of an assignment with Client, you will notify Concentric that you have finished the assignment and confirm your availability for work, regardless of who originally notified you that the assignment was ending. You will contact Concentric within one business day after completion of the assignment between the hours of 8:00 a.m. and 5:00 p.m. If you do not contact Concentric as stated in this paragraph, Concentric will assume that you are unavailable for work. You understand that failure to contact Concentric upon completion of an assignment may affect your ability to receive unemployment benefits.

  10. Acknowledgement of Employment Relationship - In addition to the rules, regulations and policies of Concentric, you agree to be bound by any applicable rules, regulations or policies established by the Client wherever you perform services under this agreement. You recognize and agree that you are an employee of Concentric and not an employee of the client, and you will look solely to Concentric for all employee benefits in connection with your employment under this agreement. You hereby waive any right you have or may have against the Client for benefits arising out of or resulting from employment hereunder, including, without limitation, rights under any medical/benefit plan, pension plan or vacation/holiday plan.

  11. Limitation of Liability - To the extent permitted by law, you, on your own behalf and on behalf of anyone claiming by or through you, waive any and all rights you have or may have, to claim or assert a claim, suit, action or demand of any kind, nature, or description, including without limitation, claims, suits, actions, or demands for personal injury or death whether arising in tort, contract, or otherwise, against Client or Client’s customers, agents, officers, directors, or employees, resulting from or arising directly or indirectly out of your employment with Concentric. You recognize and agree that Concentric provides workers’ compensation coverage for such things as on-the-job injuries or occupational diseases incurred while on assignment for Concentric, and you agree to look solely to Concentric and/or its insurer for damages and/or expenses for such injury, illness or other claims incurred while on assignment. You agree to notify Concentric if you believe that there are any unsafe conditions at the Client worksite or facility.

  If you accept this conditional offer in accordance with its stated terms, please indicate your acceptance by initialing below prior to commencing work.

• Accepted By

• Employee Initials
  
• Date

• Employee Manual

• Section 1

  Introduction

  This Manual is designed to acquaint you with Concentric Healthcare Solutions and provide you with information about working conditions and policies affecting your employment.

  The information contained in this Manual applies to all employees of Concentric Healthcare Solutions. Following the policies described in this Manual is considered a condition of continued employment. However, nothing in this Manual alters an employee’s status. The contents of this Manual shall not constitute nor be construed as a promise of employment or as a contract between the Company and any of its employees. The Manual is a summary of our policies, which are presented here only as a matter of information.

  You are responsible for reading, understanding, and complying with the provisions of this Manual. Our objective is to provide you with a work environment that is constructive to both personal and professional growth.

  1.1 CHANGES IN POLICY

  This Manual supersedes all previous employee manuals and memos that may have been issued from time to time on subjects covered in this Manual.

  However, since our business and our organization are subject to change, we reserve the right to interpret, change, suspend, cancel, or dispute with or without notice all or any part of our policies, procedures, and benefits at any time. We will notify all employees of these changes. Changes will be effective on the dates determined by the Company, and after those dates all superseded policies will be null.

  No individual or manager has the authority to change policies at any time. If you are uncertain about any policy or procedure, speak with your direct Manager.

  1.2 EMPLOYMENT APPLICATIONS

  We rely upon the accuracy of information contained in the employment application and the accuracy of other data presented throughout the hiring process and employment. Any misrepresentations, falsifications, or material omissions in any of this information or data may result in exclusion of the individual from further consideration for employment or, if the person has been hired, termination of employment.

  1.3 EMPLOYMENT RELATIONSHIP

  You enter into employment voluntarily, and you are free to resign at any time for any reason or no reason. Similarly, Concentric Healthcare Solutions is free to conclude its relationship with any employee at any time for any reason or no reason. Following the probationary period, employees are required to follow the Employment Termination Policy.

  Section 2

  EMPLOYMENT POLICIES

  2.1 NON-DISCRIMINATION

  In order to provide equal employment and advancement opportunities to all individuals, employment decisions at Concentric Healthcare Solutions will be based on merit, qualifications, and abilities. Concentric Healthcare Solutions does not discriminate in employment opportunities or practices because of race, color, religion, sex, national origin, age or disability.

  Concentric Healthcare Solutions will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship. This policy governs all aspects of employment, including selection, job assignment, compensation, discipline, termination, and access to benefits and training.

  Employees with questions or concerns about discrimination in the workplace are encouraged to bring these issues to the attention of their Manager. Employees can raise concerns and make reports without fear of reprisal. Anyone found to be engaging in unlawful discrimination will be subject to disciplinary action, including termination of employment.

  2.2 NON-DISCLOSURE/CONFIDENTIALITY

  The protection of confidential business information and trade secrets is vital to the interests and success of Concentric Healthcare Solutions. Such confidential information includes, but is not limited to, the following examples:

  • Client/Consumer information
  • External personnel data
  • Compensation data
  • Financial information
  • Marketing strategies
  • Pending projects and proposals
  • Proprietary production processes
  • Personnel/Payroll records
  • Conversations between any persons (past and present) associated with the company.

  Employees who improperly use or disclose trade secrets or confidential business information will be subject to disciplinary action, including termination of employment and legal action, even if they do not actually benefit from the disclosed information.

  2.3 OFFICE HOURS

  Concentric Healthcare Solutions office is open for business from 8 a.m. to 5 p.m. Monday through Friday, except for Holidays.

  2.4 PERSONNEL FILES

  Employee personnel files include the following: employment application, references, tax forms, offer letter, résumé, records of participation in training events, salary history, records of disciplinary action and other documents pertaining to employment with Concentric Healthcare Solutions.

  Personnel files are the property of Concentric Healthcare Solutions, and access to the information is restricted. Management personnel of Concentric Healthcare Solutions who have a legitimate reason to review the file are allowed to do so.

  Employees who wish to review their own file should contact their Manager or Human Resources Manager. With reasonable advance notice, the employee may review his/her personnel file in Company’s office and in the presence of their Manager or Human Resources Manager.

  2.5 PERSONNEL DATA CHANGES

  It is the responsibility of each employee to promptly notify their Manager or Human Resources Manager of any changes in personnel data such as:

  • Mailing address,
  • Telephone numbers,
  • Payroll changes,
  • Name and number of dependents, and
  • Individuals to be contacted in the event of an emergency.

  An employee’s personnel data should be accurate and current at all times.

  2.6 CORRECTIVE ACTION

  Concentric Healthcare Solutions holds each of its employees to certain work rules and standards of conduct. When an employee deviates from these rules and standards, Concentric Healthcare Solutions expects the employee’s Manager to take corrective action.

  Corrective action at Concentric Healthcare Solutions is progressive. That is, the action taken in response to a rule infraction or violation of standards typically follows a pattern increasing in seriousness until the infraction or violation is corrected.

  The usual sequence of corrective actions includes an oral warning (documentation recorded), a written warning, and finally termination of employment. In deciding which initial corrective action would be appropriate, a Manager will consider the seriousness of the infraction, the circumstances surrounding the matter, and the employee’s previous record.

  Though committed to a progressive approach to corrective action, Concentric Healthcare Solutions considers certain rule infractions and violations of standards as grounds for immediate termination of employment. These include but are not limited to: theft in any form, insubordinate behavior, vandalism or destruction of company property, being on company property during nonbusiness hours, the use of company equipment and/or company vehicles without prior authorization by the Executive Staff, untruthfulness about personal work history, skills, or training, divulging Company business practices, and misrepresentations of Concentric Healthcare Solutions to a customer, a prospective customer, the general public, or an employee.

  Concentric Healthcare Solutions documents all complaints to employees file that are received by facility. If employee receives DNR from facility this is reported monthly to JCAHO as well as documented in employees personnel file. A DNR will be reviewed over with the employee by either manager or HR to see what solutions can help prevent issues in future.

  2.7 EMPLOYMENT TERMINATION

  Termination of employment is an inevitable part of personnel activity within any organization, and many of the reasons for termination are routine. Below are a few examples of some of the most common circumstances under which employment is terminated:

  Resignation – voluntary employment termination initiated by an employee.

  Termination – involuntary employment termination initiated by Concentric Healthcare Solutions.

  Layoff – involuntary employment termination initiated by Concentric Healthcare Solutions for non-disciplinary reasons.

  When an employee intends to terminate his/her employment with Concentric Healthcare Solutions, he/she shall give Concentric Healthcare Solutions at least two (2) weeks written notice.

  Since employment with Concentric Healthcare Solutions is based on mutual consent, both the employee and Concentric Healthcare Solutions have the right to terminate employment at will.

  Any employee who terminates employment with Concentric Healthcare Solutions shall return all files, records, and any other materials that are property of Concentric Healthcare Solutions. No final settlement of an employee’s pay will be made until all items are returned in appropriate condition. The cost of replacing non-returned items will be deducted from the employee’s final paycheck. Furthermore, any outstanding financial obligations owed to Concentric Healthcare Solutions will also be deducted from the employee’s final check.

  2.8 SAFETY

  Concentric Healthcare Solutions provides information to employees about workplace safety and health issues through regular internal communication such as:

  Training sessions

  Team meetings

  Bulletin board postings

  Memorandums

  Other written communications

  Each employee is expected to obey safety rules and exercise caution and common sense in all work activities. Employees must immediately report any unsafe conditions to their Manager. Employees who violate safety standards, cause hazardous or dangerous situations, or fail to report, or where appropriate, remedy such situations, may be subject to disciplinary action including termination of employment.

  In the case of an accident that results in injury, regardless of how insignificant the injury may appear, employees should notify their Manager and an Incident Report must be completed and turned into Human Resources.

  2.9 HEALTH-RELATED ISSUES

  Employees who become aware of any health-related issue, including pregnancy, should notify their Manager or Human Resources Manager of health status. This policy has been instituted strictly to protect the employee.

  A written "permission to work" from the employee’s doctor is required at the time or shortly after notice has been given. The doctor’s note should specify whether the employee is able to perform regular duties as outlined in his/her job description. An unpaid leave of absence may be granted on a case-by-case basis. If the need arises for a leave of absence, employees should notify their Manager and Human Resources Manager.

  2.10 EMPLOYEE REQUIRING MEDICAL ATTENTION

  In the event an employee requires medical attention, whether injured or becoming ill while at work, the employee’s personal physician must be notified immediately. If it is necessary for the employee to be seen by the doctor or go to the hospital, a family member will be called to transport the employee to the appropriate facility. If an emergency arises requiring Emergency Medical Services to evaluate the injury/illness of an employee on-site, the employee will be responsible for any transportation charges. Furthermore, Concentric Healthcare Solutions employees will not be responsible for transportation of another employee due to liabilities that may occur. An incident report must be filled out by the employee’s Manager and submitted to Human Resources within 48 hours.

  A physician's "return to work" notice may be required.

  2.11 INSURANCE ON PERSONAL EFFECTS

  All employees should be sure that their own personal insurance policies cover the loss of anything occasionally left at the office. Concentric Healthcare Solutions assumes no risk for any loss or damage to personal property.

  2.12 IMMIGRATION LAW COMPLIANCE

  Concentric Healthcare Solutions employs only United States citizens and those non-U.S. citizens authorized to work in the United States in compliance with the Immigration Reform and Control Act of 1986.

  Each new employee, as a condition of employment, must complete the Employment Eligibility Verification Form I-9 and present documentation establishing identity and employment eligibility.

  Former employees who are rehired must also complete the form if they have not completed an I-9 with Concentric Healthcare Solutions within the past three years or if their previous I-9 is no longer retained or valid. All I-9 and documentations will be processed via E- Verify.

  Section 3

  STANDARDS OF CONDUCT

  The work rules and standards of conduct for Concentric Healthcare Solutions are important, and the Company regards them seriously. All employees are urged to become familiar with these rules and standards. In addition, employees are expected to follow the rules and standards faithfully in doing their own jobs and conducting the Company’s business. Please note that any employee who deviates from these rules and standards will be subject to corrective action, up to and including termination of employment.

  While not intended to list all the forms of behavior that are considered unacceptable in the workplace, the following are examples of rule infractions or misconduct that may result in disciplinary action, including termination of employment.

  • Theft or inappropriate removal or possession of property;
  • Falsification of timekeeping;
  • Working under the influence of alcohol or illegal drugs;
  • Possession, distribution, sale, transfer, or use of alcohol or illegal drugs in the workplace;
  • Fighting or threatening violence in the workplace;
  • Boisterous or disruptive activity in the workplace;
    • Negligence or improper conduct leading to damage of company-owned or customer-owned property;
  • Insubordination or other disrespectful conduct;
  • Violation of safety or health rules;
  • Smoking in the workplace;
  • Sexual or other unlawful or unwelcome behavior;
  • Excessive absenteeism or any absence without notice;
  • Unauthorized use of telephones, or other company-owned equipment;
    • Using company equipment for purposes other than business (i.e. playing games on computers or personal Internet usage)
  • Unauthorized disclosure of business "secrets" or confidential information;
  • Violation of personnel policies; and
  • Unsatisfactory performance or conduct.

  3.1 ATTENDANCE/PUNCTUALITY

  The Company expects that every employee will be regular and punctual in attendance. This means being at place of work, ready to work, at their starting time each day. Absenteeism and tardiness places a burden on other employees and on the Company.

  If you are unable to report for work for any reason, notify your Manager before regular starting time. You are responsible for speaking directly with your Manager about your absence. It is not acceptable to leave a message on a Manager’s voice mail, except in extreme emergencies. In the case of leaving a voice-mail message, a follow-up call must be made later that day. Should undue tardiness become apparent, disciplinary action may be required. If you miss two days or more in a row, a doctor’s note will be required before returning to work.

  3.2 HARASSMENT, INCLUDING SEXUAL HARASSMENT

  Concentric Healthcare Solutions is committed to providing a work environment that is free of discrimination and unlawful harassment. Actions, words, jokes, or comments based on an individual’s sex, race, ethnicity, age, religion, or any other legally protected characteristic will not be tolerated.

  If you believe you have been the victim of harassment, or know of another employee who has, report it immediately. Employees can raise concerns and make reports without fear of reprisal. Any Manager who becomes aware of possible harassment should promptly advise their Manager or the Human Resources Manager who will handle the matter in a timely and confidential manner.

  3.3 PUBLIC IMAGE

  Clothing that reveals too much cleavage, your back, your stomach or your underwear is not appropriate for a place of business, even in a business casual setting. Clothing should be pressed and never wrinkled. Torn, dirty, or frayed clothing is unacceptable. All seams must be finished. Any clothing that has words, terms, or pictures that may be offensive to other employees is unacceptable. Clean Hygiene is important when working with patients and others. Ensure you are presented with sanitary clothing/uniform and body when arriving to work.

  3.4 COMMUNICATION, REPORTING CHANGES

  One of the most important issues that we will stress to you is the importance of communication.

  The following list includes some important tips on how to improve your communication between your patients, their family members, co-workers and the employees in the Concentric Office.

  Report any change in a patient’s condition to the Director of Clinical Services immediately.

  Communicate appropriate information to the appropriate individuals.

  Conduct yourself in a friendly, cooperative, and professional manner with everyone. Ask questions if you do not understand something.

  Use a normal, polite speaking tone when talking to others. Raising your voice or sounding angry is unacceptable.

  Use respectful language when talking to others. The use of foul language is unacceptable. Listen when other individuals are talking. Do not hang up in the middle of a phone conversation.

  Always know who you are reporting to when you show up for your shift (i.e. staffer, charge nurse, or facility manager).

  3.5 SUBSTANCE ABUSE

  The Company is committed to providing a safe and productive workplace for its employees. In keeping with this commitment, the following rules regarding alcohol and drugs of abuse have been established for all staff members, regardless of rank or position, including both regular and temporary employees. The rules apply during working hours to all employees of the Company while they are on Company premises or elsewhere on Company business.

  The manufacture, distribution, possession, sale, or purchase of controlled substances of abuse on Company property is prohibited.

  Being under the influence of illegal drugs, alcohol, or substances of abuse on Company property is prohibited.

  Working while under the influence of prescription drugs that impair performance is prohibited.

  So that there is no question about what these rules signify, please note the following definitions:

  • Company property: All Company owned or leased property used by employees.
  • Controlled substance of abuse: Any substance listed in Schedules I-V of Section 202 of the Controlled Substance Act, as amended.
  • Drug: Any chemical substance that produces physical, mental, emotional, or behavioral change in the user.
  • Drug paraphernalia: Equipment, a product, or material that is used or intended for use in concealing an illegal drug, or otherwise introducing into the human body an illegal drug or controlled substance.
  • Illegal drug: Any drug or derivative thereof whose use, possession, sale, transfer, attempted sale or transfer, manufacture, or storage is illegal or regulated under any federal, state, or local law or regulation. Any drug, including – but not limited to – a prescription drug, used for any reason other than that prescribed by a physician. Inhalants used illegally.
  • Under the influence: A state of not having the normal use of mental or physical faculties resulting from the voluntary introduction into the body of an alcoholic beverage, drug, or substance of abuse.

  Consistent with the rules listed above, any of the following actions constitutes a violation of the Company’s policy on drugs and may subject an employee to disciplinary action, up to and including immediate termination.

  Using, selling, purchasing, transferring, manufacturing, or storing an illegal drug or drug paraphernalia, or attempting to or assisting another to do so, while in the course of employment.

  Working or reporting to work, conducting Company business or being on Company property while under the influence of an illegal drug or alcohol, or in an impaired condition.

  3.6. INSERVICES AND CONTINUING EDUCATION

  Healthcare issues continue to change on a daily basis. As healthcare providers, we constantly need to keep ourselves updates so that we can continue to provide the most effective care possible. Concentric provides an extensive in-service program, and as an employee you have the opportunity to meet your educational needs. Many states require mandatory in-services for healthcare professionals. Check with your Director of Clinical Services or Account Manager for requirements if you are unsure. Please do your part by attending our monthly in-service in the office. You can receive a list of upcoming in-services from your Director of Clinical Services. Each Concentric employee has already received credit hours by completing the Concentric orientation process and the Safety Module and by viewing the OSHA blood-borne pathogen video. Your Director of Clinical Services will keep track of your in-services and a record will be kept in your individual employee file.

  3.7 TOBACCO PRODUCTS

  The use of tobacco products is not permitted anywhere on the Company’s premises except in authorized and designated locations. Employees must follow all rules posted in designated Smoking areas and adhere to all policies associated with this policy. If excessive smoking breaks are noted that interfere with your ability to do your job or if they put undo strain on your team, disciplinary action may be taken by your Manager.

  Section 4

  PAYROLL POLICIES

  4.1 TIMEKEEPING

  Timesheets – All hourly employees must fill out time sheets are to be filled out and turned in on a weekly. It is the responsibilities of the employee to have the client sign their timesheets. Any falsification of timesheets will result in immediate termination.

  4.2 PAYDAYS

  All employees are paid weekly on Thursday.

  Paychecks will not, under any circumstances, be given to any person other than the employee without written authorization. Paychecks may also be mailed to the employee’s address or deposited directly into an employee's bank account upon request.

  If an employee has lost a paycheck, Human Resources/Payroll must be contacted so that a stop payment of the check is initiated. If the check was mailed to the home address that you provided, we must wait two weeks before requesting a stop payment and employees may be charged for bank fees related to the stop-payment process.

  4.3 JURY DUTY/MILITARY LEAVE

  Employees will be granted time off to serve on a jury or military leave without pay. However, all regular employees either full-time or part-time will be kept on the active payroll until their civic duties have been completed. A copy of the jury duty summons and all other associated paperwork are required for the personnel file.

  Section 5

  CREDENTIALING POLICIES

  5.1 OVERVIEW

  Since Concentric Healthcare Solutions works directly with hospitals, long-term care facilities, and behavioral health facilities throughout Arizona all files are kept according to hospitals standards. Our filing system organizes copies of licenses, CPR, and other certifications, tests, job descriptions, skills checklists and evaluations. Concentric keeps a separate medical file on all employees that must be managed. As mandated by federal law, all I-9 documents are filed confidentially and separately.

  Recruiters are assisted by the nursing manager, business development managers, and the compliance coordinator and are responsible for maintenance of each employee file. In addition, Concentric Personnel Solutions database system included all employee records and information as inputted. The database system "flags" all credentials needing to be updated prior to expiration. The benefit of this warning is that the Concentric Personnel Solutions office staff has adequate time to notify registry staff and receive updated documentation. Another advantage to this system is that it does not all employees to be scheduled if their credentials have expired assuming that all contractors working with facilities will have current documentation. In addition, when new credentials are input into the database, profile are immediately updated.

  5.2 CREDENTIALING

  Purpose: To outline the hiring practices for Concentric Healthcare Staffing’s Recruiters to follow during the interview and hiring process for external healthcare employees. This general guideline will insure that CHS’s Recruiters are following United States Government, Arizona State and client contractual obligations during the hiring process and we are not employing anyone who does not qualify for employment.

  Items needed for hire:

  • 2 valid forms of ID falling under the US Government’s I-9 format
  • Completion of CHS full hiring packet
  • Minimum scores of 80% or better of all credentialing testing
  • Passing OSHA tests of 80% or better
  • Passing HIPPA tests with 80% or better
  • Passing 11-panel drug test – Or Drug Test that is required per Facility
  • Passing full state and county background investigation
  • Passing OIG/SAM investigation
  • Passing Certification or License verification with the Arizona
  • State regulatory board for healthcare employee
  • Effective match to specific Job Description
  • Skills Checklist to specific Job Description
  • Two Verified References
  • EEO Form
  • Initial Physical
  • Tb Skin Test/PPD
  • TB Mask Fit
  • Chest X-Ray (if Positive)
  • Tb Questionnaire (with positive TB skin test)
  • MMR Immunization
  • Rubella/Rubeola titre or immunization
  • Varicella
  • Hep B Immunization
  • Hepatitis B Declination Form Annual
  • Tdap immunization
  • Criminal History Affidavit Notarized
  • OIG Cumulative Sanction Report
  • Fingerprinting (BHT, Peds/Geri)
  • Current CPR/BLS
  • Current First Aid
  • Current ACLS (ICU/TELE/ER)
  • Current PALS/NRP (PICU/NICU/ER)
  • Crisis Prevention Intervention (BHT)
  • Pharmacology Test (RN, LPN) Score 80 % or higher
  • Cultural Diversity
  • Professional Profile
  • Job Description
  • Substance Abuse Policy
  • Annual Performance Evaluation Need 1 on file annually
  • Health Insurance Decline/Acceptance
  • Equal Opportunity Form
  • Timesheet/Payroll Memo
  • National Patient Safety Goals

Once passed:

• Employment Eligibility (I9 Form)
• Tax Forms

5.3 COBRA BENEFITS

COBRA is the legislation that provides employees and their covered dependents the right to continue their group health care coverage after a qualifying event. COBRA legislation applies to employers with 20 or more employees. Currently Concentric Healthcare Solutions does not qualify for COBRA benefits.

Section 6

BENEFITS

6.1 HEALTH

Variable Hour Employee Notice for Concentric Healthcare Solutions

You are a variable hour employee for purposes of the new federal health reform law because you work in a job position where you generally are not expected to work more than 30 hours per week on average in a month. Your hours may fluctuate from time to time depending on business needs and how your hours are scheduled. Simply because your hours may increase from time-to-time does not mean you cease to be a variable hour employee. Variation in hours is part of your job position. Variation in hours may be such that you work over 30 hours per week for an extended time. Again, that possible hour’s variation is a normal part of your job which we anticipated when we set our annual hours expectations for this position. Such variation does not mean you are full-time for medical plan purposes nor does it indicate a “promotion.” All changes to full-time positions will be documented with a formal notice to you (similar to this Notice); in the absence of that designation by us, a change has not occurred.

Federal law states that an employer is to measure your hours worked to determine whether annual hours indicate you might become eligible for health plan coverage in the future, and so we will track your hours over a 6-month period starting with the first day of the first month following date of hire. If, at the end of the 6 months, you are then determined to be eligible, you will be offered plan coverage at that time for the following 12 months. (Coverage is never available retroactively.) You may still waive / decline the coverage; you do not have to elect our health insurance – though the new law may carry other implications for you if you have no other health insurance coverage. Review those rules with your personal financial, tax or legal advisor. If you do elect our health plan coverage at that time, you must pay your share of the premiums which will be set as required and allowed by federal law. Also, if you elect our plan coverage, federal law generally requires you must keep that coverage for the next 12 months; very limited circumstances would permit you to drop that election mid-year. For example, if your hours fall, you cannot drop the coverage, even if your pay falls as you work fewer hours; if your spouse loses his or her job, you cannot change your decision to take our coverage based on IRS rules. If your paycheck is not sufficient to pay your share of the premiums, that will be a debt you owe to us. Premiums are due by the first day of the month following the date you are first in arrears. If premiums are not paid by that date, with a 30-day grace period as provided by law, your coverage will terminate, and continuation generally will not be available. Finally, coverage ends when your employment ends.

Your hours will be tracked for each year following as well, with the timeframe depending on our formal plan year. An annual calculation will be done, and you may or may not be determined to be eligible going forward for future coverage.

Plan terms as explained in the formal plan document and summary plan description will control your rights under the plan in the event of conflicting information.

6.2 PAID TIME OFF POLICY

Effective July 1, 2017

After the employee’s 90 day probation period is complete, an employee will earn 1 hour for every 30 hours worked and will be limited to using 40 hours in 1 calendar year if available.

If paid sick time is used for 3 consecutive days the employee must submit documentation to the employer. Reasonable documentation includes documentation signed by a health care professional indicating that the earned paid sick time is necessary. In the case of domestic violence, sexual violence, abuse or stalking, the following documents are considered reasonable:

• A police report;
• A protective order, injunction against harassment, general court order, or other evidence from a court or prosecuting attorney;
• A signed statement from a domestic violence or sexual violence program, or victim services organization affirming that the employee or employee’s family member is receiving services related to domestic violence, sexual abuse, or stalking;
• A signed statement from a witness advocate concerning services from a victim services organization affirming that the employee or employee’s family member is receiving services related to domestic violence, sexual abuse, or stalking;
• A signed statement from an attorney, member of the clergy, or a medical or other professional affirming that the employee or employee’s family member is receiving services related to domestic violence, sexual abuse, or stalking ; or
• An employee’s legible, written statement concerning status of the employee or the employee’s family member as a victim of domestic violence, sexual violence, abuse, or stalking that signals the employee’s identity and (if applicable) relationship to the family member.

6.3 SOCIAL SECURITY/MEDICARE

Concentric Healthcare Solutions withholds income tax from all employees’ earnings and participates in FICA (Social Security) and Medicare withholding and matching programs as required by law.