CARE FINDERS CDPAP, LLC

1. I agree to provide all explanation, training and direction for the personal and non-personal care that is required for me to remain safe at home.

2. I acknowledge that I will inform my PA that they must have permission from Carefinders LLC, provide a Valid Driver's License and Proof of Car Insurance before driving me in a car owned by myself or the PA. I further acknowledge and understand that Carefinders LLC is in no way liable or responsible for any injuries to persons or destruction of property which may occur while my PA is driving a vehicle owned by themselves or myself during work hours to provide for my transportation.

3. I certify that I understand the Federal & NYS FALSE CLAIMS ACTS and agree to educate my PA that they should NEVER bill or accept payment for time NOT worked. I understand that this is FRAUD and that if I am found to be complicit with this act, that I, as the Consumer maybe banned from future enrollment in Federal and NYS Medicaid Programs. I may also be fined on the Federal and State Level, and be charged to repay 2x to 3x the FRAUDULENT AMOUNTS received.

4. I agree to provide my PA with any required personal Protective Equipment (PPE) that may be required for my care so that the PA may practice UNIVERSAL PRECAUTIONS as described in the Handbook. The PPE required could be some or all of the following: Gloves, Masks, Eye Shields, Disposable Smocks, Hair Covers, and Shoe Covers.

5. I agree to wear a mask and enforce all people present in my home to wear a mask when I am being cared for by the PA, to help prevent the spread of Covid 19, as well as to reduce the chances of contracting the Virus for myself or other members of my household. I understand that Carefinders LLC is in no way liable for the risk of myself or members of my household in contracting Covid 19 from a PA who is providing care in my home.

6. I agree to obtain MD Orders every 6 months from my MD to continue my CDPAP Services.

7. I agree to allow RNs from my MLTC Insurance to conduct in home or telephonic assessments that will justify my need for continued CDPAP services.

8. I agree to inform the agency if my PA were to become my Legal Spouse and to educate the PA that they must report to Carefinders CDPAP, LLC, due to my mental incapacitation, if they become my Guardian or Designated Representative, as this will disqualify them from serving as the PA.

9. I agree to allow the PA to use my personal home or cellphone to clock in/out using the EAVS system which is required by the Agency to track the time worked, as well as to provide payment to my PA for the time worked.

10.I understand that I cannot have my PA work when I am Hospitalized, in a Nursing Home, in a Rehabilitation Center or away on Vacation and out of the Service Area.

11.I agree to NEVER utilize the EW system to clock my PA In or Out for assigned work.

12. I agree to immediately report to Carefinders CDPAP, LLC if my PA if were to bill or receive payment for hours not worked as this would constitute FRAUD and disqualify me from the CDPAP Program and any future Medicaid Programs, as per the FEDERAL and NYS FALSE CLAIMS ACTS.s

13.) Have been advised that Carefinders CDPAP, is not liable or responsible for any injury to persons or property which might occur as a result of being transported by my Personal Assistant. I have been further advised that i should verify that my Personal Assistant is a duly licensed driver in the State of NY and has full coverage on his/her vehicle and its occupants, as required by the laws of the State of New York.

Dashboard CONSUMER SITE

CONSUMER NAME:*

CONSUMER ACKNOWLEDGEMENT OF GUIDELINES AND REGULATIONS*

Consumer Printed Name:*

Witness:*

Date Signed:*