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Tracey-Ann Ortiz

Employee of the month

Owner/President

John Smith

Caregiver of the Month

BUSINESS DOCUMENTS

Business tax receipts

Orange

Polk

Osceola

NEW HIRE PACKET 

Independent Contractors

• Contract to Provider Services
• Confidentially Privacy Agreement
• Attendance Policy
• Media Consent Form

Employee

• Employee Agreement
• Confidentiality Privacy Agreement
• Attendance Policy
• Media Consent Form

CLIENT'S ADMISSION PACKET

CLIENTS

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HOME HEALTH SERVICES PCS (U21) FORMS

• PCS Required Supporting Documentation Checklist
• PCS Plan of Care Form-Unlicensed Independent
• Physician Visit Documentation Form
• Medicaid Physician's Written Prescription for HHS Form
• Parent or Legal Guardian Work Schedule FORM (employed)
• Parent or Legal Guardian School Schedule Form
• Parent or Legal Guardian Medical Limitation Form

OTHER FORMS

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