Family Nurse Practitioner

I, an employee of Victory Primary Care, Inc., will not refuse care or treatment to a patient based on my cultural values or religious beliefs.

I voluntarily provided the information above and authorize a Victory Primary Care, Inc. representative to contact any person listed on my behalf in an emergency.

POLICY: The organization and its employees must comply at all times with all applicable laws and regulations. The organization will not condone conduct that achieves results through violations of law, unethical business practices, or improper patient-care practices. All business conduct must meet standards above the minimum required by law. Staff who are uncertain about any legal requirement must refer the matter to a supervisor or manager, who should seek appropriate legal guidance when necessary. These standards will be reviewed during new-employee orientation and annually thereafter, and will be included in the Employee Handbook.

1. Personnel will complete daily assignments as scheduled or assigned by the supervisor. In an emergency, personnel will notify the immediate supervisor as soon as possible during the workday.

2. Personnel will not leave the field or work area without completing scheduled visits, shifts, deliveries, or other assignments for that day.

3. All paper or electronic documentation must be completed accurately and on time. Falsification of clinical/service or billing records may result in discipline, including termination.

4. All marketing materials and verbal presentations about the organization must be accurate and truthful. Only services the organization can provide directly or under written contract may be promised. No gifts or free services may be offered to induce referrals.

5. When a patient is referred to another organization, the patient must receive an explanation of any relevant relationship.

D. Avoid voicing personal opinions about patients, families, or caregivers.

E. Do not offer medical advice.

F. Do not smoke during home visits.

G. Do not expect or accept meals from patients, families, or caregivers.

H. Do not abuse a patient's hospitality; use the telephone only for emergencies or to call the office.

I. Be punctual and responsible.

J. Do not transport patients, families, or caregivers in a car.

K. Do not take anyone into a patient's home without administrative and patient approval.

L. Complete all patient-care documentation accurately and on time.

M. Do not falsify dates, signatures, or notes in the patient record.

11. All patient-contact personnel must communicate with the office to confirm itineraries and give and receive reports according to organizational policy.

Corporate Responsibility — I understand that Victory Primary Care, Inc. has established a Corporate Compliance Program to promote ethical business practices and compliance with applicable laws and regulations. As an employee, I agree to follow the organization's policies and procedures and conduct business legally and ethically.

Confidentiality of Patient/Co-worker Information — All staff must protect information about patients and other staff. Medical information, including the fact that a person has been treated by Victory Primary Care, Inc., may be released only by authorized persons on a business need-to-know basis. Patient information, including information about staff members and their families who are patients, must remain confidential and may be discussed only as needed for treatment or to comply with legal requirements.

Confidentiality of Company Information — The confidentiality policy applies to hospice operations, activities, and business affairs, including charges, reimbursement rates, and contracts. Company information must be kept strictly confidential and shared only with appropriate personnel. It may not be disclosed outside the workplace during or after employment. Questions should be directed to the immediate supervisor.

System Security — I understand that access to the Victory Primary Care computer system is limited to work-related functions for which I am responsible or that the company asks me to perform. I may not share my password, leave it unsecured, sign in for an unauthorized person, or use any system identification other than the valid ID assigned to me for each application or device.

As a recipient of federal financial assistance, Victory Primary Care, Inc. does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, or age in admission to, participation in, or receipt of services and benefits, or in employment, whether carried out directly or through a contractor or other entity. This policy is intended to comply with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, applicable Department of Health and Human Services regulations, and Section 1557 of the Affordable Care Act. Other federal laws provide similar protection against discrimination based on sex and creed.

Questions or complaints concerning this policy may be directed to Victory Primary Care at 818-601-8016. The policy is distributed to staff, patients, the community, minority and disability groups, and referral sources; posted conspicuously at the agency; included in personnel policies; and made available to patients, caregivers, family members, and employees during normal business hours.

I have read and understand the Victory Primary Care Conflict of Interest Policy and will conduct myself to avoid actual or potential conflicts related to my position. I and my family members have or anticipate the affiliations, interests, or transactions described below. Check “None” where applicable and use additional space as needed.

Outside Employment or Service — Identify any current or planned outside employment or services that may create a conflict.

Gifts, Gratuities, Services, and Entertainment — Identify gifts, gratuities, services, or entertainment with a cumulative market value of $250 or more in one fiscal year, or an individual value of $50 or more, that you or your family accepted and that might reasonably influence your judgment or actions concerning hospice business.

Family or Business Relationship Conflicts — Identify family or business relationships with trustees, officers, key employees, or other hospice employees.

Other — Identify any other activity involving you or your family that may constitute a conflict.

I certify that the information above is true to the best of my knowledge. I agree to promptly file another disclosure if circumstances change. I understand that failure to provide accurate information or update this statement may result in discipline, up to and including termination.

Victory Primary Care prohibits and does not tolerate sexual abuse in the workplace or in any hospice-related activity. Employees, volunteers, family members, board members, patients, victims, and others may report sexual abuse. No person, regardless of title or position, has authority to commit or allow sexual abuse. Victory Primary Care maintains a zero-tolerance policy. Following investigation, discipline up to and including termination and criminal prosecution may occur.

Sexual abuse is inappropriate sexual contact of a criminal nature or an interaction for the gratification of an adult caregiver responsible for a patient or child. It includes sexual molestation, sexual assault, sexual exploitation, or sexual injury, but does not include sexual harassment. Incidents reasonably believed to have occurred will be reported to appropriate law-enforcement and regulatory agencies.

Possible physical signs: • Difficulty walking • Torn, stained, or bloody underwear • Pain or itching in the genital area • Bruising or bleeding of external genitalia • Sexually transmitted disease

Possible behavioral signs: • Reluctance to be left alone with a particular person • Wearing many layers of clothing, especially in bed • Fear of touch • Nightmares or fear of night • Apprehension when sex is discussed

Reporting Procedure — Immediately report known or suspected abuse to your supervisor. Suspected abuse of an adult should be reported to the Elder Abuse Hotline at (602) 542-4446. Suspected abuse of a child should be reported to the Child Abuse Hotline at (888) 767-2445. Appropriate family members will be notified. The alleged incident should also be reported to the Governing Body of Victory Primary Care.

Retaliation against a person who makes a good-faith complaint or participates in an investigation is prohibited. Knowingly false, malicious allegations and deliberate false statements during an investigation are prohibited and may result in discipline, including termination.

Investigation and Follow-up — Victory Primary Care will take allegations seriously and promptly conduct a fair and impartial investigation. The source packet identifies Veritas Associates, 480-204-0911, for investigation support. Victory Primary Care will cooperate with law enforcement and regulatory agencies and may place the accused on leave or in a non-patient-contact assignment. The organization will make reasonable efforts to preserve confidentiality while allowing a prompt and thorough investigation.

Victory Primary Care prohibits abuse, neglect, exploitation, and retaliation. All employees, contractors, and volunteers must protect patients and other vulnerable persons from harm and immediately report known or suspected mistreatment.

DEFINITIONS — Abuse includes intentional physical harm, unreasonable confinement, sexual abuse or assault, verbal or emotional mistreatment, and injury caused by negligent acts or omissions. Neglect includes failure to provide necessary care, food, shelter, medication, supervision, or protection. Exploitation includes improper or unauthorized use of a person’s money, property, identity, benefits, or resources. Self-neglect may include a vulnerable adult’s inability to meet essential needs when health or safety is at risk.

Possible indicators include unexplained injuries, bruises or burns; sudden fear or withdrawal; poor hygiene; dehydration or malnutrition; missed medications; unsafe or unsanitary living conditions; pressure to sign documents; missing money or belongings; unusual banking activity; or a caregiver preventing private communication.

IMMEDIATE SAFETY — If a patient or other person is in immediate danger or needs urgent medical assistance, call 911. Do not confront the alleged perpetrator, conduct your own investigation, promise secrecy, or delay a required report. Preserve relevant evidence and document only objective facts.

MANDATORY REPORTING — A staff member who has a reasonable basis to believe that abuse, neglect, or exploitation of a vulnerable adult has occurred must immediately report or cause a report to be made according to Arizona law and agency procedure. Report to the supervisor or administrator immediately and ensure that a report is made to law enforcement or Arizona Adult Protective Services. Suspected child abuse or neglect must be reported immediately to law enforcement or the Arizona Department of Child Safety.

REPORTING CONTACTS — Emergency: 911. Arizona Adult Protective Services: 1-877-SOS-ADULT (1-877-767-2385); online reporting is available 24 hours a day. Arizona Child Abuse Hotline: 1-888-SOS-CHILD (1-888-767-2445). Concerns involving a licensed or unlicensed health care facility may also be reported to the Arizona Department of Health Services at (602) 364-2536. Internal reporting does not replace any legally required external report.

Retaliation against anyone who makes a good-faith report or participates in an investigation is prohibited. Staff must cooperate with authorized investigations, maintain confidentiality to the extent permitted by law, and follow directions intended to protect the patient. Knowingly false or malicious reports are prohibited.