CONTRACT FOR SERVICES

Between HOSPICE COMFORT CARE and

HHCH Home Care

This Agreement is made this 09 day of February, 2011, between Hospice Comfort Care of NJ
(“Hospice”) a New Jersey corporation, with its principal place of business at 238 Broadway,
Bayonne, NewJersey and HHCH Home Care Agency (“Contractor”).

WHEREAS, Contractor is qualified and available to provide the professional services required
by Hospice,

NOW THEREFFORE, in consideration of the mutual promises contained herein, the parties
hereby agree as follows:

Contractor agrees:

1. As expressly authorized and as requested by Hospice, and in accordance with Hospice

Patient Care Policies, to provide Home Health Aides services to Hospice Patients who are
referred to the Contractor pursuant to this agreement.
2. To provide services, including initial evaluation, periodic re-evaluations and
recommendations for revisions to the Interdisciplinary Plan of Care.
3. To provide Hospice with complete written documentation of all evaluations, treatment
plans and goals, patient/caregiver teaching, progress notes and outcomes of care in
accordance with this Agreement. Original documentation will be submitted to Hospice
within (7) days of the delivery of services.
4. A verbal report should be called in to the Hospice (Director or available team member)
subsequent to written documentation being delivered to/mailed to the Hospice office.
5. To coordinate the scheduling of visits with the patient/caregiver and the primary registered
nurse (RN) and to notify patient/caregiver in a timely manner when unable to keep
scheduled visit.
6. To participate in Interdisciplinary Team meetings when requested by Hospice.
7. To respond to request by Hospice for the provision of services within 24 hours of receipt of
request from Hospice.
8. To participate in an orientation to Hospice Policies, Procedures and function.
9. Provide documents necessary (in a timely manner) to maintain a current personnel file
according to agency policy.
10. To comply with all requirements relating to professional qualifications and standards, state
and federal regulations and licensure requirements at all times during the term of this
agreement.
11. To hold in strict confidence all Patient records and disclose information and data in such
records only to persons or entities authorized by law or by written authorization.
12. To submit to a criminal history check, TB skin test as defined in Hospice Personnel Policy.

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Hospice agrees:

1. To maintain exclusive responsibility for admitting and discharging patients to the Hospice
program.
2. To initiate requests for services of the contractor and to make available all Patient records
and information necessary for contractor to provide services.
3. To maintain financial, administrative and professional management responsibility for the
services provided to the Patient, including those provided by the Contractor.
4. To monitor contractor services to ensure that contractor services are furnished in a safe and
effective manner, by persons meeting qualifications necessary to provide effective Hospice
care and in accordance with the Patient’s Interdisciplinary Plan of Care, including specified
visit frequency and other requirements of regulatory and accrediting bodies.
5. To provide Hospice orientation to the Contractor.
6. To maintain updated, correct Physician’s orders and Patient Plan of Care.

Coordination, Supervision and Evaluation

1. In fulfilling the obligations pursuant to this Agreement, Contractor shall be accountable to

Hospice with regard to the extent and nature of the services to be rendered to Hospice
Patients.
2. Hospice shall designate a registered nurse (RN) to coordinate the implementation of the
Interdisciplinary Plan of Care for each Hospice Patient. Hospice will also ensure
availability of a registered nurse (RN ) to be on-call 24 hours per day, seven days per week,
for consultation to the Contractor regarding implementation of the Interdisciplinary Plan of
Car and services rendered pursuant to this agreement.
3. Hospice shall coordinate, supervise and evaluate the quality and appropriateness of care
provided by the program, including the services that are provided by the Contractor. The
Contractor will assist and participate in Performance Improvement activities as requested.

Independent Contractor

Contracted Professional shall at all times be an independent contractor. Nothing in this

agreement is intended, nor shall be construed, to create an employee/employer relationship.

Contractor will be responsible for own income tax, social security and unemployment insurance.

Reimbursement

Hospice will compensate Contractor for approved services rendered as follows:

$16.50 per hour.
Payday will be every two weeks or within 30 days of receipt of all Patient documentation and
presentation of bill/invoice from the contacted service.

This contract will continue and be binding upon both parties unless terminated as herein
provided. It may be amended by written consent of both parties and all amendments will be
attached to this contract and made part thereof. Either party may terminate this contract by the
giving of fourteen (14) days written notice of intention to the other party. This contract may be
immediately terminated in the event the Contractor fails to satisfy all of the qualifications set
forth in this contract.

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HOSPICE: CONTRACTOR:

(Print) ______________________________

__________________________________
____________________________________
(Authorized Representative)

__________________________________
____________________________________
(Date) (Date)

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