JOB DESCRIPTION/PERFORMANCE EVALUATION

NAME: _________________________________________________ JOB FUNCTION: _______________

CONTRACT AGENCY: __________________________________________ DATE: _________________

This performance evaluation provides the contract worker and the organization with a clear understanding of the

contract worker’s ability to perform the skill and work requirements in relation to their job.

Performance Rating

10 Distinguished - consistently meets and often exceeds performance standards.

8 Exceeds Expectations - consistently meets and sometimes exceeds performance standards.

6 Meets Expectations - meets all relevant performance standards; seldom exceeds or falls short of desired results.

4 Needs Improvement - sometimes meets the performance standards; seldom exceeds or often falls short of desired results.

2 Unsatisfactory - consistently performs below standards: does not adequately accomplish objectives nor fulfill all responsibilities.

Choose applicable contract worker. Score job functions using the Performance Ratings listed above:

LICENSED NURSE: Performs hands-on nursing care by utilizing the nursing process to achieve quality patient outcomes.

Administers medication according to hospital policy and procedures within the designated time frames.

Performs head-to-toe assessment on each assigned patient each shift.

Documents nursing interventions, changes in patient's condition, MD visits, etc on the Nurses Daily flow sheet, according to hospital P&P.

Identifies changes to patients' condition, including tests and lab results, vital signs, physical findings, etc. and reports to CN as indicated.

NURSING ASSISTANT: Able to obtain vital signs to include temperature, pulse, blood pressure, respirations, SaO2 and I&O accurately every shift.

Able to recognize potential for or actual skin problems and reports to the nurse on an as needed basis.

Able to bathe patients according to hospital policy and procedure on a daily basis. Able to perform ADL's as directed by the nurse.

Follows fall risk protocol by careful observation of those patients that are at risk for falls.

Able to obtain accurate patient weight using rolling sling bed scale, wheel chair scale, bed scale and/or standup scale.

Demonstrates safe and proper transfer techniques and body mechanics when working with patients.

Correctly administers dysphagia techniques during meal time with patients that have swallowing problems.

LICENSED RESPIRATORY THERAPIST: Possesses know ledge and skills for basic airway maintenance and advanced airway maintenance if indicated.

Performs arterial punctures to obtain arterial blood gas analysis, if indicated by physician's order.

Demonstrates know ledge and understanding of oxygen concentrations and medication doses as they relate to patients.

Demonstrates know ledge and understanding of the differences in techniques and treatment modalities as performed on patients.

Manages/operates equipment in a safe manner. Inspects/tests respiratory therapy equipment to ensure that it is functioning safely.

Oversees the documentation of all pertinent data on the respiratory therapy progress notes with each visit.

THERAPY (PT/OT/ST/COTA/PTA) Initiates evaluation and completes it within 3 days of receiving an order.

Evaluates the patient to determine rehab potential, identifies needs, and sets goals to be used in the team plan of care.

Identifies appropriate parts of the evaluation w hen completion is not possible. Prioritizes treatment, completes per policy.

Seeks out resources in difficult cases

Sets initial STG's and LTG's.; utilizes treatment approaches according to established therapy protocols and policies. Identifies patient and family education needs; Collaborates with the team to establish interdisciplinary team goals.

The following Personal Performance Evaluation applies to all contract workers. Score using the Performance Ratings listed above: Attendance and Punctuality - the extent to which an employee is punctual, observes prescribed work/meal breaks.

Personal Appearance - the extent to which an employee dresses and presents themselves according to established hospital guidelines; wears

identification badge at all times while on duty.

Teamwork - the extent to which an employee demonstrates the ability to cooperate, work and communicate with co-workers, supervisors, subordinates; readiness to respond positively to instructions and procedures.

Infection Control - the extent to which an employee adheres to the infection control guidelines/precautions as defined by hospital P&P.

*Contract Worker must score at least ‘6’ or higher in each category to be considered a satisfactory employee.

I have reviewed this JOB DESCRIPTION and feel that I am capable of fulfilling all job responsibilities.

Contract Worker Signature:___________________________________________________________Date:____________

I have reviewed my PERFORMANCE EVALUATION.

Contract Worker Signature:___________________________________________________________ Date: ___________

Hospital Representative Signature:______________________________________________________ Date: ___________

LHC Group 11/07; rev 1/17

SIGNATURE RECORD

___________________________________ PRINT NAME AND CERTIFICATIONS ABOVE

Department: ____________________________________________________________

Hospital: _______________________________________________________________

SIGNATURE :___________________________________________________________

INITIALS: _____________________________________________________________

LHC Group 11/07

CONFIDENTIALITY AND NON-DISCLOSURE

AGREEMENT

As a contracted employee of LHC Group, its member agencies, managed sites, and any

affiliated organization, I understand that contact with confidential information occurs as a

part of daily business operations. Confidential information includes, but is not limited to,

medical information, insurance information, and financial information. This information

is vital to the operation of the organization and therefore constitutes business critical data.

I acknowledge and agree that certain information described in this Agreement constitutes

personal and confidential information belonging to LHC Group patients and clients, and

that disclosure of such personal and/or confidential information will constitute a breach

of confidentiality. I further acknowledge and agree that I am subject to immediate

termination in the event I breach the confidentiality of any patient or client of LHC

Group, or if I disclose any information subject to this Agreement to any third person.

Confidential information can come in many forms, including written, verbal, and

electronic formats. I understand that technological advances could create new means of

processing and communicating confidential information and could be utilized by LHC

Group. I understand that the equipment and any software that makes these devices

operate is company property and that in its use confidential business critical information

is processed. I understand that it is my responsibility to make LHC Group aware of

problems or issues related to breaches of confidentiality.

One of the most important methods of protecting business critical data in the electronic

format is through the implementation of passwords. Passwords are the front line defense

in protecting computer system access from unauthorized individuals. I acknowledge that

my password(s) can provide access to confidential business data and agree to keep my

password(s) strictly confidential.

I agree that a breach of this Agreement will result in the irreparable injury and therefore

agree and understand that LHC Group may seek injunctive relief to prevent disclosure of

any information subject to this Agreement.

This Agreement shall be construed in accordance with the laws of the state, and any

dispute arising hereunder shall be heard by a court of competent jurisdiction in the State.

____________________________________ ______________________ Contracted Employee Signature Date

LHC Group 11/07

LHC Group LTAC Contract Worker

ATTESTATION for ORIENTATION MATERIAL

ATTESTATION for education provided regarding the following topics:

Environmental Safety (Hazard Communication, Emergency Preparedness, Fire Prevention)

Infection Control

HIPAA

Restraint Education

LHC Group, Inc. (“LHC Group”) requires that all contract workers who provide services to any of our long-term

acute care hospitals (“LTACs”) receive, read, understand and agree to abide by the required education as follows:

Environmental Safety (Hazard Communication, Emergency Preparedness, Fire Prevention), Infection Control,

HIPAA (Health Insurance Portability and Accountability Act), Restraint Education.

I hereby certify that I am a contract worker who has been requested to provide services to one or more of LHC

Group’s LTACs.

I hereby further certify that I have received and read the educational material for: Environmental Safety (Hazard

Communication, Emergency Preparedness, Fire Prevention), Infection Control, HIPAA, and Restraints.

I have had an opportunity to ask questions and have my questions answered to my satisfaction about the required

educational material.

ATTESTATION of review of LHC Group Hospital Handbook

I acknowledge that I have read and understand the information contained in the LHC Group Hospital Handbook. I

have had an opportunity to have all of my questions answered. I agree to abide by the policies set forth by the LHC

Group.

(NURSES ONLY)

ATTESTATION of review of LHC Group Orientation Booklet for Nurses

I acknowledge that I have read and understand the information contained in the LHC Group Orientation Booklet

for Nurses. I have had an opportunity to have all of my questions answered. I agree to abide by the policies set

forth by the LHC Group.

Date: ________________________ Contract Worker (print name): ___________________________________________________ Contract Worker (signature): _____________________________________________________ LHC Group 1/18

LHC Group LTAC Contract Worker

Code of Conduct and Ethics and Compliance Training Attestation

LHC Group, Inc. (“LHC Group”) requires that all contract workers who provide services to any of our long-term

acute care hospitals (“LTACs”) receive, read, understand and agree to abide by the LHC Group Code of Conduct

and Ethics. LHC Group also requires that all LTAC contract workers complete LHC Group’s one (1)-hour Business

Ethics, Compliance, Privacy & Security compliance training course.

I hereby certify that I am a contract worker who has been requested to provide services to one or more of LHC

Group’s LTACs.

I hereby further certify that I have received and read the LHC Group Code of Conduct and Ethics.

I hereby agree to fully comply with the LHC Group Code of Conduct and Ethics and understand that compliance

with the LHC Group Code of Conduct and Ethics is a condition of my contract and is required in order for me to

perform services on behalf of LHC Group.

I further understand that violation of the LHC Group Code of Conduct and Ethics may lead to termination of my

contract with LHC Group and my inability to continue performing services on behalf of LHC Group.

I hereby further certify that I have received, read and completed the LHC Group one (1)-hour Business Ethics,

Compliance, Privacy & Security compliance training course. I acknowledge that LHC’s Chief Compliance Officer

is available to answer any questions or provide any additional information needed regarding such compliance

training. I hereby agree to fully comply with the content addressed in the LHC Group one (1)-hour Business Ethics,

Compliance, Privacy & Security compliance training course in my capacity as a contract worker at any LHC Group

LTAC. Contract Worker Last Name:

Contract Worker First Name:

Contract Worker Last Four Digits of Social Security Number:

Contract Worker Date of Birth: Date Contract Worker Completed Training: (Month / Day / Year) (Month / Day / Year)

/ / / /

Contract Worker Signature Date