HHA/PCA Orientation Packet
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Agency Representative Name
Starting Date
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Month
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Day
Year
Hire Date
Agency Representative Signature:
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Live-In Policy Disclaimer
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By clicking the submit button, I agree to the terms & conditions.
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First Name:
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Last Name:
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Street Address:
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Apartment/Suite #:
City:
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State:
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AK
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CA
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Zip:
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Mobile Phone Number:
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Home Phone Number:
Employee Email:
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Social Security Number:
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Date of Birth:
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Month
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All B-Well Home Care Agency, Inc. personnel are required to follow the Rule of Conduct and avoid actions that result in a conflict of interest.
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I am not currently employed by another Home Care Agency or any other organizations.
I Am currently employed by another Home Care Agency
I Am currently employed by another Organization
Quiz
1. Hepatitis B requires a series of __________________________ injections
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A. One
B. Four
C. Three
D. None of the above
2. There is a vaccination against HIV
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A. True
B. False
3. Proper hand washing requires lathering with soap for at least ______________ seconds.
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A. 5 seconds
B. 30 seconds
C. 20 seconds
D. 1 minute
4. If your patient falls what is your responsibility?
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A. Call 911, call your agency and inform the family
B. Nothing leave the patient alone as long as there are no injuries
C. Pick the patient up
5. You are not allowed to share your patient’s medical or personal information because of the HIPPA Confidentiality Law:
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A. True
C. False
6. The first thing you should do when exposed to blood or body fluids is:
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A. Wash the needle stick or cut with soap and water
B. FIush splashes to the nose mouth and skin with water
C. Irrigates eye with water saline or sterile irrigates
D. All of the above
7. You must wear your Bwell ID at all times
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A. True
B. False
8. It is ok for you to check your patient’s blood sugar if they are diabetic and you know how to do it:
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A. True
B. False
9. It is ok for you to wear dangling earrings and have long fingernails:
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A. True
B. False
10. The best way to prevent the spread of TB is to know the signs and symptoms which are bloody sputum, chills, fever, fatigue, chest pain, night sweats and weight loss
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A. True
B. False
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Employee Signature:
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