EMPLOYEE ADD/REHIRE FORM

The employee handbook describes important information about HCC Network, and I understand that I should consult my Supervisor, Director, Vice President of Operations or CEO regarding any questions not answered in the handbook. I have entered into my employment relationship with HCC Network voluntarily and acknowledge that there is no specified length of employment.

Accordingly, either I or HCC Network can terminate the relationship at will, with or without cause, at any time, so long as there is not violation of applicable federal or state law.

I understand and agree that, other than the CEO and Chief Administrative Officer of the organization, no manager, supervisor or representative of HCC Network has any authority to enter into any agreement for employment other than at will; only the CEO and Chief Administrative Officer of the organization has the authority to make any such agreement and then only in writing signed by the CEO or Chief Administrative Officer of HCC Network. The CEO and Chief Administrative Officer is charged with interpretation of the handbook for all implementation purposes.

This handbook and the policies and procedures contained herein supersede any and all prior practices, oral or written representations, or statements regarding the terms and conditions of my employment with HCC Network. By distributing this handbook, the organization expressly revokes any and all previous policies and procedures that are inconsistent with those contained herein.

I understand that, except for employment-at-will status, any and all policies and practices may be changed at any time by HCC Network, and the organization reserves the right to change my hours, wages and working conditions at any time. All such changes will be communicated through official notices, and I understand that revised information may supersede, modify or eliminate existing policies. Only the CEO or Chief Administrative Officer of HCC Network has the ability to adopt any revisions to the policies in this handbook.

I understand and agree that nothing in the Employee Handbook creates, or is intended to create, a promise or representation of continued employment and that employment at HCC Network is employment at will, which may be terminated at the will of either HCC Network or myself. Furthermore, I

acknowledge that this handbook is neither a contract of employment nor a legal document. I understand and agree that employment and compensation may be terminated with or without cause and with or without notice at any time by HCC Network or myself.

I have received the handbook, and I understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it.

Purpose: The intent of this policy is to alert employees to the need for discretion at all times and is not intended to inhibit normal business communication.

General: Our clients and other parties with whom we do business entrust HCC Network with personal and private information that may include or pertain to protected health information. It is our policy that all information considered protected and confidential will not be disclosed to external parties or to employees without a “need to know”. If there is a question of whether certain information is considered confidential, the employee should first check with his/her immediate supervisor.

I hereby acknowledge, by my signature below, that I understand that the Personal Health Information (PHI), other confidential records, and data to which I have knowledge and access in the course of my employment with HCC Network is to be kept confidential, and this confidentiality is a condition of my employment. This information shall not be disclosed to anyone under any circumstances, except to the extent necessary to fulfill my job requirements. I understand that my duty to maintain confidentiality continues even after I am no longer employed.

I am familiar with the guidelines in place at HCC Network pertaining to the use and disclosure of patient PHI or other confidential information. Approval should first be obtained before any disclosure of PHI or other confidential information not addressed in the guidelines and policies and procedures of HCC Network is made. I also understand that the unauthorized disclosure of patient PHI and other confidential or proprietary information of HCC Network is grounds for disciplinary action, up to and including immediate dismissal.

I hereby give my consent for HCC Network to use my photograph and likeness in its publications, including its website and video. I release them from any expectation of confidentiality for the undersigned listed below.

I agree that I am committed to ensuring quality patient care and will comply with all quality guidelines and take direction from the quality staff, led by HCC Chief Medical Officer.

I understand that compliance with OSHA standards are a condition of my employment and are not negotiable.

This statement is to be read and signed by all employees at least annually. It is prudent to ensure that duality of interest be identified by each employee and that any potential conflict of interest, real or perceived, be avoided through established HCC Network procedures.

The use of alcohol and/or non-prescribed controlled substance is not an acceptable practice while performing HCC Network activities, during normal working hours or at other times when performing said activities.

Any employee who may sustain an injury which is related to or actually caused by the use of alcohol and/or non-prescribed controlled substances while preforming HCC Network activities shall find the Worker’s Compensation benefits reduced or forfeited.

Employees will sign form regarding notice of this policy and it will be retained in employee personnel record.

All HCC Network employees are subject to a series of appropriate criminal background checks as a condition of employment to be updated at least annually. These checks include the following: Criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years; sex offender registry searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided; and searches for exclusion records from receiving federal contracts, certain subcontracts, and from certain types of federal financial and non-financial assistance and benefits.

I hereby authorize HCC Network to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist HCC Network in collecting this information.

I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to employment. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner which is safe for HCC Network patients, employees, and other community members.

Please print (for identification purposes):

To the best of my knowledge, the information provided in this Notice and Authorization and any attachments thereto is true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for the severance of my employment with HCC Network. By signing below I hereby provide my authorization to HCC Network to conduct a criminal background check and I acknowledge that I have been provided with a summary of my rights under the Fair Credit Reporting Act. In addition to those rights, I understand that I have a right to appeal an adverse employment decision made by HCC Network based on my background check information within three business days of receipt of such notice and that a determination on my appeal will be made in seven working days from HCC Network's receipt of such appeal.

Please list the high school, college, or university, from which you received your highest level of education.

I hereby authorize HCC Network to contact the institution listed on my application for employment or curriculum vitae to verify my attendance and degree status.

REQUIREMENT: All providers engaged in clinical activities are required to have a physical exam in advance of beginning their clinical responsibilities. This requirement is in addition to meeting the HCC Network requirement for submitting health history and immunization information. The details of both health history and immunization information are listed in the HCC Network Handbook. Other requirements are also detailed in the HCC Network Handbook. Please note that over the course of your employment, you may also be subject to additional specific requirements if requested by your immediate supervisor. This Fitness for Duty Form must be signed and dated by a licensed primary care provider.

You may NOT sign your own Fitness for Duty form.

HCC Network utilizes Short Message Service (SMS) or texting to notify employees of closures, emergencies, etc. Mass texting can be a quicker and more convenient way to reach all employees simultaneously than other forms of communication. This form is for each employee to opt in or out of receiving HCC Network mass texts.

o Text messaging with HCC Network is completely voluntary. I do not have to agree to text messaging to be employed with HCC Network. o If an employee is issued a work device or cell phone with text messaging capabilities, that number will automatically be enrolled in the HCC Network mass text feature. o If I do consent today, I can change my mind at any time and opt out of HCC Network’s SMS communications. If I do, I will contact HCC Network’s Human Resources Department to update my SMS Consent Form. The Human Resources Department will notify the necessary parties to remove my personal cell phone number from HCC Network’s SMS communication services. Once I have notified HCC Network that I have chosen to opt out of SMS communications, HCC Network will no longer send text messages to the number I have listed below. o This is a one-way SMS communication service. HCC Network will send SMS communications to me, but HCC Network cannot receive my responses. o Text messages are sent over the internet. They are not encrypted. HCC Network does not use secure text messaging. The text messages I receive from HCC Network may be read by others. o I will tell HCC Network immediately if the number I have listed below has changed. Until I do, HCC Network will assume that any text messages it sends to the number I have listed below are being sent and received by me. o My cell phone service provider may charge me for receiving text messages. HCC Network will not pay for text messages I receive. HCC Network does not know whether there will be a charge or how much I will be charged for text messaging because that is between me and my cell phone service provider. o Some examples of what HCC Network may text me include, but are not limited to o HCC Network location closures due to weather conditions o HCC Network location closures due to other unforeseen circumstances o HCC Network location lock downs

I authorize HCC Network to communicate with me through standard text messaging or SMS. These communications may include confidential information not

to be disclosed to media, on social media, or to community members outside of HCC Network employment. All other policies that relate to the sharing of information or the use of technology must be followed.

(New Employee) I hereby authorize HCC Network to initiate credit entries and if necessary, initiate debit corrections or adjustment entries to my account(s) at the financial institution(s) indicated below.

(Institution, Account #, and/or Amount)

I understand that: 

1. The following documents and/or notices may be provided to me electronically:

1. Summary Plan Descriptions (SPDs)
2. Summaries of Benefits and Coverage (SBCs)
3. Summaries of Material Modifications (SMMs)
4. Summary Annual Reports (SARs)
5. Annual Compliance Notices

2. I may provide notice of a revised email address or revoke my consent at any time without charge by sending an email to chelsea.bargfrede@hccnetwork.org or by calling (660) 259 2440.

3.I am entitled to request and obtain a paper copy of any electronically furnished document free of charge by contacting chelsea.bargfrede@hccnetwork.org or by calling (660) 259-2440

4.In order to access information provided electronically, I must have: a.A computer with Internet access b.An email account that allows me to send and receive emails c.Microsoft Work or Adobe Acrobat Reader

I agree to electronic delivery of notices provided to me