• PRIMARY CARE SOLUTIONS

    PRIMARY CARE SOLUTIONS

  • CONSENT TO PERFORM

  • CRIMINAL HISTORY BACKGROUND CHECK

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  • This authorization and consent for release of personal information acknowledges that PCSOH (hereafter referred to as "Company") and/or its agent, Secure Search, may now, or at any time I am assigned to, volunteer with, or am employed by this Company, conduct investigations whether the records are of a public, private, or confidential nature. These investigations might include, but are not limited to, searches of educational institutions attended; previous employment, including work history; criminal history information on file in local, state, or federal agencies; and motor vehicle records.

    I understand that these searches will be used to determine work assignment or employment eligibility under the Company's employment or volunteer policies. Therefore, I authorize and consent to the full release of records (either orally or in writing) to the authorized representatives of the Company. In addition, I release and discharge the Company, its agent, and associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs, expenses, or any other charge or complaint filed with any agency arising from retrieving and reporting this information.

    I understand that according to the Federal Fair Credit Reporting Act, I am entitled to know whether employment was denied based upon the information obtained and to receive, upon written request, a disclosure of the background report. After reading this document, I fully understand its contents and authorize the background verification.

     

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    THIS SECTION IS TO BE USED TO LIST ALL COUNTIES AND STATES OF RESIDENCE IN THE PAST 5 YEARS

    I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS AUTHORIZATION IS TRUE, CORRECT, AND COMPLETE. I UNDERSTAND THAT IF ANY INFORMATION PROVES TO BE INCORRECT OR INCOMPLETE, GROUNDS FOR THE CANCELING OF ANY AND ALL OFFERS OF EMPLOYMENT OR VOLUNTEER POSITIONS WILL EXIST AND MAY BE USED AT THE DISCRETION OF THE EMPLOYER.

  • Signed this * day of 20     
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  • AT WILL EMPLOYMENT CLAUSE: Employment contract provision indicting that employer or employee may terminate the employment relationship at any time with or without cause.

    In consideration of employer entering into this agreement, employee agrees to conform to the policies and rules of employer in effect from time to time. Each party to this agreement also agrees that employee's employment and compensation can be terminated with or without cause, and without prior notice, at any time options of either employee or employer.

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  • Assurance of Confidentiality & Federal Privacy Regulations

  • I *, have agreed to comply with all Confidentiality and Privacy Rules and Requirements in accordance with Federal and Ohio laws and regulations, by virtue of the contractual agreement with Primary Care Solutions of Ohio, Inc, and the completion of this Assurance for Confidentiality form. Confidentiality information includes (but is not limited to) photographs, videotapes, audiotapes, client records, reimbursement records; information stored in automated files, and clinical staff member client files.I am aware that violation of this agreement could result in disciplinary actions at Primary Care Solutions of Ohio Inc and is a violation of Federal and Ohio laws that could result in civil penalties
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    Confidentiality and Non-Disclosure Agreement

    In consideration of employment of the undersigned (Employee) by Primary Care Solutions of Ohio (or any successor thereto), and in consideration of the wages and salary to be Paid. Employee agrees to the following:

    1. Statement of Confidentiality

    Employee hereby attests that in his/her role with Primary Care Solutions, understand and accepts that they have access to the confidential information, but not limited to, client names, addresses and personal data, billing records, accounts, wages financials, and trust funds.

    Employee further understands that it is a violation of federal and state law to reveal confidential information, and subject to legal action for violation of applicable laws. Employee I also understand that it is against company Policy to reveal confidential information of any type to anymore not privileged to receive such information. Employee pledges absolutely to maintain, during and beyond employment with Primary Care Solutions, the confidentiality and security of this information as well as any of Primary Care Solutions proprietary information.

  • 2. Statement of Non-Disclosure

    Employee acknowledges that not to disclose of confidential information to Anyone other than persons authorized by Primary Care Solutions. Employee agrees to safeguard this confidential

    a. to any other than Primary Care Solutions and officers or other persons, including employees authorizes by Primary Care Solutions, or use or otherwise exploit Employees will not directly or indirectly disclose for the Employee's own Benefit or for the benefit of anyone other than Primary Care Solutions, and Confidential information whether Such material is developed before or after the date of this Agreement or employee's employment with Primary Care Solutions.

    b. Employees shall use his or her best efforts to cause all persons or entities to whom any Confidential Information shall be disclosed by him or her hereunder to observe the terms and conditions set forth herein as though each such person or entity were bound hereby.

     

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    Confidentiality and Non-Disclosure Agreement continued

    C. Employee shall have no obligation hereunder to keep confidential and Confidential Information if and to the extent disclosure of any such information is specifically required by law or if the information has been released to the public by Primary Care Solutions, provided, however, that in the Event discloser is required by applicable law. Employee shall Provide Primary Care Solutions with prompt notice to Such requirement, prior to making any disclosure, so that Primary Care Solutions may seek appropriate protective

    3. Information, data and Materials constituting Confidential Information Confidential information

    includes, but is not limited to, such items,

    a. any patent, patent application, copyright, trademark, trade name, service mark, service names," know-how" or trade secrets.

    b. individuals we serve and information relating to any such individual or any party

    c. customer lists and information relating to any client of Life Enhancement Services or any part-/related.

    d. company records, operational methods and company policies and procedures, including manual and forms.

    e. marketing data, plans and strategies.

    f. business acquisitions, development expansion or capital investment plan activities.

    g. software and any other confidential technical programs.

    h. personnel information, employee payroll and benefits data.

    i.accounts receivable and accounts payable.

    j. other financial information, including financial statements, budgets, projections, earnings and any unpublished financial information.

    k.company correspondence and communications and communications with outside

    l. information, data and materials developed by Employee.

     

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    Confidentiality and Non-Disclosure Agreement continued

    4. Statement of Property

    Assignment of intellectual Property rights to Primary Care Solutions Employer agrees to assign and transfer to Primary Care Solutions his or her entire right title interest in and to any and all improvements, new ideas or concepts or other innovation made or developed by Employee "innovations" either solely or jointly with other during the course of employment. Employee agrees to make and maintain Adequate and current written records of all such Innovations in the form of notes or report relating thereto; which records shall be remaining the property of and be available to Primary Care Solutions at all times. Employee agrees to promptly Disclose SO Primary Care Solutions all such innovations and shall not claim and Additional or special payment for such assignment.

    5. Returns

    Return of Confidential Information Upon Termination Upon termination of employment of whatever reason, Employee aggress to return Immediately to Primary Care Solutions (Employee Supervisor) any and all Confidential information, including copies, extracts or other reproductions, in Employee's possession or control.

    6. This is Not a Contract of Employment

    Agreement Does Not Constitute Contract of Employment Agreement Does Not Constitute Contract of employment Employee acknowledge that his Agreements address only the treatment of confidential Information and does not constitute A contract of employment not does it guarantee any continued employment of employees by Primary Care Solutions.

    7. Survival

    The termination of Employee's employment, for whatever reason, shall not Extinguish and obligations of Employee hereunder.

    8. Enforcement of Agreement

    Primary Care Solutions shall be entitled to specific performance and injunctive or other equitable relief for any breach of this agreement. IN WITNESS WHEREFORE, Employee signed this agreement as of the data written below.

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    Drug and Alcohol Policy

    This policy is being distributed to all Primary Care Solutions employees in compliance with the provisions and the Drug-Free Workplace Act of 1988 (41 U.S.C; Section 701, et.seg)

    Individuals Covered by the Policy:

    This policy applies to all employees (including hourly) who work at Primary Care Solutions and in workplaces controlled by Primary Care Solutions.

    1. Policy Guidelines

    A. Employees

    Primary Care Solutions absolutely prohibits the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance or alcohol on company premises or while conducting company business off company premises. Violation of this policy may result in immediate termination of employment or other appropriate disciplinary actions. "Controlled substances" are those usually referred to as illegal drugs listed under the federal Controlled Substances Act.

    B. Compliance with the Drug-Free Workplace Act of 1988

    As a condition of employment, all staff must: Notify the Director of Human Resources of any conviction under a criminal drug statute for violations occurring on or off Primary Care Solutions premises while conducting company business. When the Department of Human Resources receives notice of such a conviction, it will coordinate efforts to comply with the reporting requirements of the Drug-Free Workplace Act of 1988.

    2. Policy Enforcement

    An employee who: (1) Is found to be under the influence of alcohol or a controlled substance while on Primary Care Solutions property or in the course of company business; (2) Uses alcohol or controlled substances during working hours, or (3) Is convicted of a criminal alcohol or drug statute violation occurring on company property is subject to disciplinary action, up to and including termination.

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  • HIPPA Compliance Form

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    The Health Insurance Portability and Accountability Act (HIPAA) is the Federal law that establishes standards for the privacy and security of health information. This law requires HIPAA training for all personal at Primary Care Solutions. Federal regulations also require documentation that each employee has received and read the training information that will

    By signing and returning this form I confirm that I have received training and written documentation for Primary Care Solutions HIPAA Compliance Policy. I also hereby agree to adhere to all federal regulations and Primary Care Solutions policy in reference to HIPAA.

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