Agreements

CLEAN HANDS PURE HEARTS
Home Health & Adult Day Services
4696 Honeygrove Road Suite 102 Virginia Beach, VA 23455
Phone: (757) 271-5507 Fax: (757) 720-4068 care@cleanhandspureheartsllc.com
Confidentiality Agreement
This Confidentiality Agreement ("Agreement") is entered into between Clean Hands Pure Hearts LLC ("Company") and the undersigned employee, contractor, volunteer, intern, or representative ("Employee").
The purpose of this Agreement is to protect the confidentiality, privacy, and security of all clients, participants, employees, business operations, and proprietary information associated with Clean Hands Pure Hearts LLC.
1. Confidential Information
Employee understands that during the course of employment or association with the Company, they may have access to confidential and protected information including, but not limited to:
- Client names, medical records, diagnoses, treatment plans, and personal information
- Protected Health Information ("PHI") under HIPAA regulations
- Employee records and payroll information
- Business operations, policies, procedures, pricing, and financial information
- Referral sources, marketing strategies, vendor information, and contracts
- Login credentials, passwords, software systems, and electronic records
- Any information designated as confidential by the Company
Employee agrees that all confidential information is the sole property of Clean Hands Pure Hearts LLC.
2. Non-Disclosure
Employee agrees to:
- Keep all confidential information strictly confidential
- Not disclose confidential information to any unauthorized person or entity
- Not copy, photograph, text, email, print, or remove confidential information without authorization
- Only access information necessary to perform assigned job duties
- Follow all HIPAA, state, and federal confidentiality laws and regulations
This obligation remains in effect during employment and after separation from the Company.
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CLEAN HANDS PURE HEARTS
3. HIPAA Compliance
Employee acknowledges that Clean Hands Pure Hearts LLC is required to comply with the Health
Insurance Portability and Accountability Act (HIPAA).
Employee agrees to:
- Protect all Protected Health Information (PHI)
- Report any suspected privacy or security breaches immediately
- Use secure communication methods when handling client information
- Never discuss client information in public or unauthorized settings
Violation of HIPAA regulations may result in disciplinary action, termination, civil penalties, and/or
criminal penalties.
4. Return of Company Property
Upon separation from the Company, Employee agrees to immediately return all Company property
including:
- Files and records
- Keys and access cards
- Laptops, phones, tablets, and electronic devices
- Training materials and handbooks
- Passwords and login access information
Employee shall not retain copies of Company information in any form.
5. Violation of Agreement
Violation of this Agreement may result in:
- Immediate disciplinary action up to and including termination
- Legal action by the Company
- Financial liability for damages caused by unauthorized disclosure
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CLEAN HANDS PURE HEARTS
Acknowledgment
By signing below, Employee acknowledges that they have read, understand, and agree to comply with this Confidentiality Agreement.
CLEAN HANDS PURE HEARTS LLC
Employee Name:
Employee Signature:
Date:

MonthDayYear
Date
Witness/Company Representative:
Date:

MonthDayYear
Date
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NON-COMPETE, NON-SOLICITATION, AND CONFIDENTIALITY AGREEMENT
This Non-Compete, Non-Solicitation, and Confidentiality Agreement ("Agreement") is entered into on this ____________ day of ____________, by and between:
Clean Hands Pure Hearts LLC ("Company"), located at 4696 Honeygrove Road, Suite 102, Virginia Beach, VA 23455
and
Employee Name:
1. Purpose
Employee acknowledges that during employment with the Company, Employee will have access to confidential and proprietary information including, but not limited to:
- Client and participant information
- Referral sources and marketing contacts
- Policies and procedures
- Employee information
- Operational systems and workflows
- Pricing structures and financial information
- Business development strategies
- Vendor and insurance relationships
Employee agrees that the protections contained in this Agreement are reasonable and necessary to protect the legitimate business interests of the Company.
2. Non-Compete Covenant
During Employee's employment with the Company and for a period of two (2) years following separation of employment for any reason, Employee shall not, directly or indirectly:
- Own, manage, operate, consult for, assist with, or be employed by any competing business substantially similar to the services offered by the Company;

- Open or participate in any home care agency, personal care agency, adult day center, respite care business, community engagement program, skilled home health agency, therapy-based healthcare company, or related healthcare support business that competes with the Company.
This restriction shall apply within a 50-mile radius of any Company office location or service area operated by the Company at the time of Employee's separation.
3. Non-Solicitation
For a period of two (2) years following separation from the Company, Employee shall not directly or indirectly:
- Solicit, recruit, or hire any employee or contractor of the Company;
- Solicit or attempt to solicit any client, participant, referral source, vendor, insurance partner, or business relationship of the Company for competing services;
- Encourage any client, participant, or employee to discontinue their relationship with the Company.
4. Confidentiality
Employee agrees that all confidential and proprietary information obtained during employment shall remain the exclusive property of the Company.
Employee shall not disclose, duplicate, retain, use, or distribute any confidential information for personal benefit or for the benefit of another individual or business during or after employment.
This confidentiality obligation shall survive termination of employment indefinitely.
5. Liquidated Damages
Employee acknowledges that a breach of this Agreement would result in substantial harm to the Company that may be difficult to calculate.
Accordingly, Employee agrees that any violation of this Agreement shall result in liquidated damages in the amount of Fifty Thousand Dollars ($50,000.00), in addition to any other

remedies available to the Company under applicable law, including injunctive relief, attorney's fees, court costs, and actual damages.
6. Severability
If any provision of this Agreement is found to be unenforceable under applicable law, the remaining provisions shall remain valid and enforceable to the fullest extent permitted by law.
7. Governing Law
This Agreement shall be governed by and interpreted in accordance with the laws of the Commonwealth of Virginia.
8. Entire Agreement
This Agreement represents the complete understanding between the parties concerning non- competition, confidentiality, and non-solicitation obligations and supersedes any prior verbal or written agreements regarding these matters.
COMPANY
Clean Hands Pure Hearts LLC
By:
Name:
Title:
Date:

MonthDayYear
Date
EMPLOYEE
Employee Signature:
Printed Name:
Date:

MonthDayYear
Date

CLEAN HANDS PURE HEARTS
Home Health & Adult Day Services
4696 Honeygrove Road Suite 102 Virginia Beach, VA 23455
Phone: (757) 271-5507 • Fax: (757) 720-4068 • care@cleanhandspureheartsllc.com
Direct Deposit Authorization Form
I hereby authorize Clean Hands Pure Hearts LLC to deposit my payroll earnings directly into the
financial institution account listed below.
Employee Information
Employee Name:
Address:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Banking Information
Account Type
Bank Name:
Routing Number:
Account Number:
Authorization
I authorize Clean Hands Pure Hearts LLC to initiate electronic credit entries and, if necessary, debit
entries and adjustments for any credit entries made in error to my account listed above.
This authorization will remain in effect until I provide written notice of cancellation.
Employee Signature:
Date:

MonthDayYear
Date
Attach One of the Following
Attachment Options
Physical Therapy • Speech Therapy • Occupational Therapy • Medication Management • In Home Care • Adult Day Center •
Wound Care

CLEAN HANDS PURE HEARTS
Home Health & Adult Day Services
4696 Honeygrove Road • Suite 102 • Virginia Beach, VA 23455
Phone: (757) 271-5507 • Fax: (757) 720-4068 • care@cleanhandspureheartsllc.com
HEPATITIS B VACCINATION DECLINATION
I understand that due to my occupational exposure to blood or other potentially infectious materials, I may be at risk of acquiring Hepatitis B Virus (HBV) infection.
I have been given the opportunity to receive the Hepatitis B vaccination series at no cost to me.
However, at this time, I decline the Hepatitis B vaccination.
I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease.
If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to receive the Hepatitis B vaccination series, I may do so at no cost to me, if eligible.
Employee Signature:
Date:

MonthDayYear
Date
Witness Signature:
Date:

MonthDayYear
Date
HEPATITIS B VACCINATION DOCUMENTATION
EMPLOYEE INFORMATION
Employee Name:
Position/Title:
VACCINATION STATUS
Date(s) Received:
Dose 1:

MonthDayYear
Date
Dose 2:

MonthDayYear
Date
Dose 3:

MonthDayYear
Date
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CLEAN HANDS PURE HEARTS
Booster (if applicable):
DOCUMENTATION PROVIDED
Reviewed By:
Title:
Signature:
Date:

MonthDayYear
Date
OSHA COMPLIANCE NOTE
This documentation is maintained in accordance with OSHA Bloodborne Pathogens Standard requirements and agency infection control policies.
Physical Therapy • Speech Therapy • Occupational Therapy • Medication Management • In Home Care • Adult Day Center • Wound Care
Should be Empty:

CLEAN HANDS PURE HEARTS

Confidentiality Agreement

1. Confidential Information

2. Non-Disclosure

CLEAN HANDS PURE HEARTS

3. HIPAA Compliance

4. Return of Company Property

5. Violation of Agreement

CLEAN HANDS PURE HEARTS

Acknowledgment

CLEAN HANDS PURE HEARTS LLC

NON-COMPETE, NON-SOLICITATION, AND CONFIDENTIALITY AGREEMENT

1. Purpose

2. Non-Compete Covenant

3. Non-Solicitation

4. Confidentiality

5. Liquidated Damages

6. Severability

7. Governing Law

8. Entire Agreement

COMPANY

EMPLOYEE

CLEAN HANDS PURE HEARTS

Direct Deposit Authorization Form

Employee Information

Banking Information

Authorization

Attach One of the Following

CLEAN HANDS PURE HEARTS

HEPATITIS B VACCINATION DECLINATION

HEPATITIS B VACCINATION DOCUMENTATION

EMPLOYEE INFORMATION

VACCINATION STATUS

CLEAN HANDS PURE HEARTS

OSHA COMPLIANCE NOTE