DISCLAIMER AND WAIVER OF LIABLITY


DISCLAIMER AND WAIVER OF LIABLITY

I acknowledge and will adhere to the rules and regulations as set forth by the Department of Aging and Disability Services and Medicare and Medicaid. I understand that the falsification of documents, particularly those pertaining to the submission of visit notes where in fact no visit was made, is considered to be fraud and is subject to filing of a criminal grievance, civil and/or criminal prosecution, and immediate termination. I therefore hold the Home Health agency, its shareholders, directorsand officers, harmless from any falsified documents.

I have read and understand the above information. I understand that the falsification of documents, particularly those pertaining to the submission of visit notes where in fact no visit was made, is considered to be fraud and is subject to filing of a criminal grievance, civil and/or criminal prosecution, and immediate termination.