Abby Services Orientation
Welcome to Abby Services Inc., we are a Nurse Registry which is a Caregiver Referral Service licensed by the State of Florida. Once you, herein the Independent Contractor, complete the registration process, we will be referring patients who have contacted Abby Services to find qualified providers of Home Health Care Services to meet their personal needs. The following information provides you with;
-State regulations governing Independent Contractors and Nurse Registries: When you register with Abby Services, you receive a copy of the Florida Statutes that govern the care you can provide to patients, your relationship as an Independent Contractor with Abby Services, information about Alzheimer’s disease, and your role in the emergency management plan. You acknowledge with signature, (Form F8.8) your receipt and understanding of this information. It is your responsibility to thoroughly review the Florida statutes and know what services you can and cannot provide.
-Independent Contractors waive the right to Workers Compensation and Unemployment Insurance: Your Independent Contractor status is acknowledged by you upon completion of the Independent Contractor Registration, and the federal government tax form (W-9). As an Independent Contractor, you acknowledge that you waive the right to workers compensation and unemployment insurance. You are not an employee of Abby Services.
-Your tax responsibility as an Independent Contractor: As an Independent Contractor you are responsible for paying your own income taxes and self-employment taxes including Social Security and Medicare taxes. A yearly income of $600 or more is reported to the federal government on IRS form 1099-misc. You must pay income taxes and you may deduct your business expenses related to the income generated. Failure to pay income taxes is a felony. It is a good idea to consult a tax professional for detailed information regarding your tax obligation. In addition, you acknowledge with your signature the Business Associates Confidentiality Agreement designed to protect the patient’s confidential health information.
-Invoicing the patient for your services: Abby Services invoices each patient on a weekly basis on your behalf. All invoicing must be accurately documented to include the dates you worked, the hours you worked, and the services the patient requested of you that you preformed. Each shift you work should be initialed by your patient or by the Independent Contractor relieving you. Abby Services collects payments from the patient for your services on your behalf and deposits these payments into an escrow account. Since you are paid prior to the patient being invoiced, the initial payments to you are considered a cash advance. Abby Services is paid from the escrow account through referral fees charged to you based on hours worked.
-Acceptance of Patients: Acceptance of patients is the choice of the Independent Contractor. You will be notified of patients wishing to obtain services. You will be provided with the patient’s name, address, phone number, diagnosis and hours of service requested. It is your option to accept the assignment or not. Once accepted, you are responsible for the timely delivery of care as requested by the patient. In the event that you are unable to provide services as requested by your client, it is your responsibility to notify your client. This can be done through Abby Services who has a representative available 24/7. Many patients authorize Abby Services to refer a qualified replacement for the scheduled shift if you are unable to meet their needs. If you can’t care for the patient for any reason let us know. Acceptance of a case is a two way street. If the patient isn’t happy with the services you provided they can request that you be replaced. Patients direct the care they receive. They decide what you are to do while you are in their home. Be cautious not to agree to provide any service outside the scope of your discipline. Florida statutes define what you legally can do and cannot do, you have received Administrative code 59A-18.0081 which outlines the services you are permitted to provide. RN’s and LPN’s are responsible for being familiar with state laws regulating their profession (Nurse Practice Act).
-Information pertaining to Alzheimer’s Disease: Practical information on Alzheimer’s disease is included in your orientation with approaches to be considered when working with these special patients.
-Emergency Management Plan: All Independent Contractors are responsible for reviewing their client’s emergency plan on file with Abby Services. We have included details about our emergency management plan in your orientation.
-Abuse: It is the responsibility of the person who hears, sees, or suspects abuse or exploitation to personally report this to the Department of Children and Families at 1-800-96-ABUSE.
59A-18.009 Homemakers or Companions.
(1) The homemaker or companion shall have evidence of training in topics related to human development and interpersonal relationships, nutrition, shopping, food storage, use of equipment and supplies, planning and organizing of household tasks and principles of cleanliness and safety:
(2) The homemaker shall have the following responsibilities:
(a) To maintain the home in the optimum state of cleanliness and safety depending upon the client’s and the caregiver’s resources;
(b) To perform the functions generally undertaken by the natural homemaker, including such duties as preparation of meals, laundry, and shopping;
(c) To perform casual, cosmetic assistance, such as brushing the client’s hair, assisting with make-up, filing and polishing nails, although for more advance cosmetic procedures people can go here for plastic surgery boston online.
(d) To stabilize the client when walking, as needed, by holding the client’s arm or hand; and
(e) To report any unusual incidents or changes in the patient’s or client’s behavior to the nurse registry administration and to the caregiver.
(3) The companion shall have the following responsibilities:
(a) To provide companionship for the patient or client;
(b) To provide escort services such as taking the patient or client to the doctor;
(c) To provide light housekeeping tasks such as preparation of a meal or laundering the client’s personal garments;
(d) To perform casual, cosmetic assistance, such as brushing the client’s hair, assisting with make-up, filing and polishing nails, with the exception of clipping nails for diabetic patients; and
(e) To stabilize the client when walking, as needed, by holding the client’s arm or hand; and
(f) To report any unusual incidents or changes in the patient’s or client’s behavior to the nurse registry administration and to the caregiver.
(4) Each nurse registry shall ensure that homemakers and companions understand the needs of the patients or clients to whom they are referred and are able to recognize those conditions that need to be reported to the nurse registry office.
(5) Homemakers and companions shall be responsible for providing to patient and nurse registry copies of any documentation which reflects the services provided. This will be stored by the nurse registry in the client’s file.
59A-18.0081 Certified Nursing Assistant and Home Health Aide. The certified nursing assistant (C.N.A.) and the home health aide shall:
(1) Be limited to assisting a patient in accordance with Section 400.506(10)(b), F.S.;
(2) Be responsible for documenting services provided to the patient or client and for filing said documentation with the nurse registry on a regular basis. These service logs will be stored by the nurse registry in the client’s file. The service logs shall include the name of the patient or client and a listing of the services provided;
(3) Be responsible for observing appearance and gross behavioral changes in the patient and reporting these changes to the caregiver and the nurse registry or the registered nurse responsible for assessing the case when giving care in the home or to the responsible facility employee if staffing in a facility;
(4) Be responsible to maintain a clean, safe and healthy environment, which may include light cleaning and straightening of the bathroom, straightening the sleeping and living areas, washing the patient’s dishes or laundry, and such tasks to maintain cleanliness and safety for the patient;
(5) Perform other activities as taught and documented by a registered nurse, concerning activities for a specific patient and restricted to the following:
(a) Assisting with the change of a colostomy bag, reinforcement of dressing;
(b) Assisting with the use of devices for aid to daily living such as a wheelchair or walker;
(c) Assisting with prescribed range of motion exercises;
(d) Assisting with prescribed ice cap or collar;
(e) Doing simple urine tests for sugar, acetone or albumin;
(f) Measuring and preparing special diets;
(g) Measuring intake and output of fluids; and
(h) Measuring temperature, pulse, respiration or blood pressure.
(6) Be prohibited from changing sterile dressings, irrigating body cavities such as giving an enema, irrigating a colostomy or wound, performing gastric irrigation or enteral feeding, catheterizing a patient, administering medications, applying heat by any method, or caring for a tracheotomy tube.
(7) For every CNA, a nurse registry shall have on file a copy of the person’s State of Florida certification.
(8) For every home health aide, a nurse registry shall have on file documentation of successful completion of at least forty hours of training, pursuant to Section 400.506(10)(a), F.S., in the following subject areas:
(a) Communication skills;
(b) Observation, reporting and documentation of patient status and the care or services provided;
(c) Reading and recording temperature, pulse and respiration;
(d) Basic infection control procedures;
(e) Basic elements of body functions that must be reported to the patient’s registered nurse or physician;
(f) Maintenance of a clean, safe, and healthy environment;
(g) Recognition of emergencies and knowledge of emergency procedures;
(h) Physical, emotional, and developmental characteristics of the populations served by the registry, including the need for respect for the patient, his privacy, and his property;
(i) Appropriate and safe techniques in personal hygiene and grooming, including bed bath, sponge, tub, or shower bath; shampoo, sink, tub, or bed; nail and skin care; oral hygiene;
(j) Safe transfer techniques and ambulation;
(k) Normal range of motion and positioning;
(l) Adequate nutrition and fluid intake;
(m) The role of the aide in the home;
(n) Differences in families;
(o) Food and household management; and
(p) Other health-related topics pertinent to home health aide services offered in the home.
(9) Individuals who earn their CNA certificate in another state must contact the Florida Certified Nursing Assistant office at the Department of Health to inquire about taking the written examination prior to working as a CNA in Florida, pursuant to Part II of Chapter 464, F.S.
(10) Home health aides who complete their training in another state must provide a copy of the course work and a copy of their training documentation to the nurse registry. If the course work is equivalent to Florida’s requirements, the nurse registry may refer the home health aide for contract. If the home health aide’s course work does not meet Florida’s requirements, the home health aide must receive training in a school approved by the Department of Education to the extent necessary to bring the training into compliance with subsection 59A-18.0081(8), F.A.C., prior to being referred for contract.
(11) CNAs and home health aides referred by nurse registries must maintain a current CPR certification;
(12) C.N.A.s and home health aides referred by nurse registries may assist with self-administration of medication as described in Section 400.488, F.S.
(a) Home health aides and C.N.A.s assisting with self-administered medication, as described in Section 400.488, F.S., shall have received a minimum of 2 hours of training covering the following content:
(b) Documentation of training on assistance with self-administered medication from one of the following sources is acceptable:
(c) Documentation of training must be maintained in each home health aide and C.N.A. file who assists patients with self-administered medication.
(d) In cases where a home health aide or a C.N.A. will provide assistance with self-administered medications as described in Section 400.488, F.S., and paragraph (e) below, a review of the medications for which assistance is to be provided shall be conducted by a registered nurse or licensed practical nurse to ensure the C.N.A. and home health aide are able to assist in accordance with their training and with the medication prescription. The patient or the patient’s surrogate, guardian, or attorney in fact must give written consent for a home health aide or C.N.A. to provide assistance with self-administered medications, as required in Section 400.488(2), F.S.
(e) The trained home health aide and C.N.A. may also provide the following assistance with self-administered medication, as needed by the patient and as described in Section 400.488, F.S.:
59A-18.007 Registered Nurse and Licensed Practical Nurse. The registered nurse and the licensed practical nurse shall:
(1) Be responsible for the clinical records for their patients. The clinical records shall be filed with the nurse registry, for each patient or client to whom they are giving care in the home or place of residence or when they assess the care being provided by non-licensed independent contractors, pursuant to Section 400.506(10)(c), F.S. Clinical notes and clinical records related to care given under a staffing arrangement are maintained by the facility where the staffing contract is arranged;
(2) Be responsible for maintaining the medical plan of treatment with clinical notes and filing the initial medical plan of treatment, any amendments to the plan, any additional order or change in orders, and a copy of the clinical notes at the office of the nurse registry;
(3) The licensed practical nurse shall be under the direction of a registered nurse, or a physician licensed pursuant to Florida Statutes, as required under Section 464.003(3)(b), F.S.
59A-18.011 Medical Plan of Treatment.
(1) When the delivery of care to a patient in the home is under the direction or supervision of a physician or when a physician is responsible for the medical care of the patient, a medical plan of treatment must be established for each patient receiving care or treatment provided by the licensed nurse in the home or residence.
(2) The licensed nurse providing care to the patient is responsible for having the medical plan of treatment signed by the physician, physician assistant, or advanced registered nurse practitioner, acting within his or her respective scope of practice, within 30 days from the initiation of services and reviewed by the physician, physician assistant, or advanced registered nurse practitioner in consultation with the licensed nurse at least every 2 months.
(3) The licensed nurse responsible for delivering care to the patient is responsible for the medical POT which shall include, at a minimum, the following:
(b) Activities permitted when indicated;
(c) Diet when indicated;
(d) Medication, treatments, and equipment required; and
(e) Dated signature of physician, physician assistant, or advanced registered nurse practitioner.
(4) The delivery of care pursuant to a medical plan of treatment must be substantiated by the nursing notes or documentation made by the nurse in compliance with nursing practices established under Chapter 464, F.S.
(5) The initial medical plan of treatment, any amendment to the plan, additional orders or change in orders, and copy of clinical notes must be filed in the office of the nurse registry, pursuant to Section 400.506(15)(b), F.S., within 30 days, pursuant to Section 400.497(7), F.S.
(6) The nurse registry shall inform nurse registrants that the shift nurse that communicates with the physician’s office, the physician assistant or the advanced registered practitioner about any changes in the orders should update the plan of treatment.
(7) The patient, caregiver or guardian must be informed by independent contractors of the nurse registry that:
(a) They have the right to be informed of the medical plan of treatment;
(b) They have the right to participate in the development of the medical plan of treatment;
(c) They may have a copy of the medical plan of treatment if requested; and
(d) The caregiver being referred is an independent contractor of the registry.
59A-18.012 Clinical Records. The licensed nurse responsible for the delivery of patient care shall maintain a clinical record, pursuant to Section 400.497(6), F.S., for each patient receiving nursing services in the home that shall include, at a minimum, the following:
(1) Identification sheet containing the patient’s name, address, telephone number, date of birth, sex, and caregiver or guardian;
(2) Before information can be released, an authorization for such release must be dated and signed by the patient, caregiver, or guardian;
(3) Plan of treatment as required in Section 400.506(17), F.S.;
(4) Clinical and service notes, signed and dated by the nurse providing the service which shall include:
(a) Any assessments by a registered nurse;
(b) Progress notes with changes in the person’s condition;
(c) Services provided;
(d) Observations; and
(e) Instructions to the patient and caregiver;
(5) Reports to physicians;
(6) Termination summary including:
(a) The date of the first and last visit;
(b) The reason for termination of services;
(c) An evaluation of established goals at time of termination;
(d) The condition of the patient at the time of termination of services; and
(e) The referral for additional services when the patient requires continuing services.
(7) Each nurse registry shall keep clinical records received from the independent contractor licensed nurse for 5 years following the termination of service. Retained records can be stored as hard paper copy, microfilm, computer disks or tapes and must be retrievable for use during unannounced surveys.
59A-18.013 Administration of Drugs and Biologicals.
(1) Each nurse registry shall disseminate to its independent contractor nurses the procedures required by Chapter 464, F.S. and the rules of the Agency for Health Care Administration governing the administration of drugs and biologicals to patients.
(2) The procedures shall include the following:
(a) An order for medications to be administered by the licensed nurse shall be dated and signed by the attending physician, physician assistant, or advanced registered nurse practitioner as required in Section 400.506(17), F.S.;
(b) An order for medications shall contain the name of the patient, the name of the drug, dosage, frequency, method or site of injection, and order from the physician, physician assistant, or advanced registered nurse practitioner if the patient or caregiver are to be taught to give the medication; and
(c) A verbal order for medication or change in the medication orders from the physician, physician assistant, or advanced registered nurse practitioner shall be taken by a licensed registered nurse, reduced to writing, to include the patient’s name, the date, time, order received, signature and title. The physician, physician assistant, or advanced registered nurse practitioner shall acknowledge the telephone order within 30 days by signing and dating the orders. A verbal order or change in medication order shall be on file in the clinical record at the nurse registry within 30 days.
59A-18.005(6) Health Statements and Communicable Disease
Prior to contact with patients, each independent contractor referred for client care must furnish to the registry a statement from a health care professional licensed under Chapter 458, F.S., or Chapter 459, F.S., a physician’s assistant, or an advanced registered nurse practitioner (ARNP) or a registered nurse licensed under Chapter 464, F.S., under the supervision of a licensed physician, or acting pursuant to an established protocol signed by a licensed physician, based upon an examination within the last six months, that the contractor is free from-communicable disease. If any independent contractor is later found to have, or is suspected of having, a communicable disease, he or she shall immediately cease to be referred as an independent contractor. If the independent contractor later provides a statement from a health care professional that such condition no longer exists, then the nurse registry can again refer patients to the independent contractor. It is the responsibility of the independent contractor to ensure that patients are not placed at risk by immediately removing him or herself as a caregiver if he or she is found to have or is suspected of having a communicable disease. In the event that an independent contractor refuses to remove him or herself, the nurse registry shall report the situation to the county health department as an immediate threat to health, welfare and safety.
400.506 Licensure of nurse registries; requirements; penalties
(1) A nurse registry is exempt from the licensing requirements of a home health agency but must be licensed as a nurse registry. The requirements of part II of chapter 408 apply to the provision of services that require licensure pursuant to ss. 400.506–400.518 and part II of chapter 408 and to entities licensed by or applying for such license from the Agency for Health Care Administration pursuant to ss. 400.506–400.518. A license issued by the agency is required for the operation of a nurse registry. Each operational site of the nurse registry must be licensed, unless there is more than one site within a county. If there is more than one site within a county, only one license per county is required. Each operational site must be listed on the license.
(2) Each applicant for licensure and each licensee must comply with all provisions of part II of chapter 408 and this section.
(3) In accordance with s. 408.805, an applicant or licensee shall pay a fee for each license application submitted under ss. 400.506–400.518, part II of chapter 408, and applicable rules. The amount of the fee shall be established by rule and may not exceed $2,000 per biennium.
(4) A person that provides, offers, or advertises to the public any service for which licensure is required under this section must include in such advertisement the license number issued to it by the Agency for Health Care Administration. The agency shall assess a fine of not less than $100 against any licensee who fails to include the license number when submitting the advertisement for publication, broadcast, or printing. The fine for a second or subsequent offense is $500.
(5)(a) In addition to the requirements of s. 408.812, any person who owns, operates, or maintains an unlicensed nurse registry and who, within 10 working days after receiving notification from the agency, fails to cease operation and apply for a license under this part commits a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083. Each day of continued operation is a separate offense.
(5)(b) If a nurse registry fails to cease operation after agency notification, the agency may impose a fine of $500 for each day of noncompliance.
(6)(a) A nurse registry may refer for contract in private residences registered nurses and licensed practical nurses registered and licensed under part I of chapter 464, certified nursing assistants certified under part II of chapter 464, home health aides who present documented proof of successful completion of the training required by rule of the agency, and companions or homemakers for the purposes of providing those services authorized under s. 400.509(1). A licensed nurse registry shall ensure that each certified nursing assistant referred for contract by the nurse registry and each home health aide referred for contract by the nurse registry is adequately trained to perform the tasks of a home health aide in the home setting. Each person referred by a nurse registry must provide current documentation that he or she is free from communicable diseases.
(6)(b) A certified nursing assistant or home health aide may be referred for a contract to provide care to a patient in his or her home only if that patient is under a physician’s care. A certified nursing assistant or home health aide referred for contract in a private residence shall be limited to assisting a patient with bathing, dressing, toileting, grooming, eating, physical transfer, and those normal daily routines the patient could perform for himself or herself were he or she physically capable. A certified nursing assistant or home health aide may not provide medical or other health care services that require specialized training and that may be performed only by licensed health care professionals. The nurse registry shall obtain the name and address of the attending physician and send written notification to the physician within 48 hours after a contract is concluded that a certified nursing assistant or home health aide will be providing care for that patient.
(6)(c) When a certified nursing assistant or home health aide is referred to a patient’s home by a nurse registry, the nurse registry shall advise the patient, the patient’s family, or any other person acting on behalf of the patient at the time the contract for services is made that registered nurses are available to make visits to the patient’s home for an additional cost.
(7) A person who is referred by a nurse registry for contract in private residences and who is not a nurse licensed under part I of chapter 464 may perform only those services or care to clients that the person has been certified to perform or trained to perform as required by law or rules of the Agency for Health Care Administration or the Department of Business and Professional Regulation. Providing services beyond the scope authorized under this subsection constitutes the unauthorized practice of medicine or a violation of the Nurse Practice Act and is punishable as provided under chapter 458, chapter 459, or part I of chapter 464.
(8) Each nurse registry must require every applicant for contract to complete an application form providing the following information:
(a) The name, address, date of birth, and social security number of the applicant.
(b) The educational background and employment history of the applicant.
(c) The number and date of the applicable license or certification.
(d) When appropriate, information concerning the renewal of the applicable license, registration, or certification.
(e) Proof of completion of a continuing educational course on modes of transmission, infection control procedures, clinical management, and prevention of human immunodeficiency virus and acquired immune deficiency syndrome with an emphasis on appropriate behavior and attitude change. Such instruction shall include information on current Florida law and its effect on testing, confidentiality of test results, and treatment of patients and any protocols and procedures applicable to human immunodeficiency virus counseling and testing, reporting, offering HIV testing to pregnant women, and partner notification issues pursuant to ss. 381.004 and 384.25.
(9) Each nurse registry must comply with the background screening requirements in s. 400.512 for all persons referred for contract. However, an initial screening may not be required for persons who have been continuously registered with the nurse registry since October 1, 2000.
(10) The nurse registry must maintain the application on file, and that file must be open to the inspection of the Agency for Health Care Administration. The nurse registry must maintain on file the name and address of the patient or client to whom nurse registry personnel are referred for contract and the amount of the fee received by the nurse registry. A nurse registry must maintain the file that includes the application and other applicable documentation for 3 years after the date of the last file entry of patient-related or client-related information.
(11) Nurse registries shall assist persons who would need assistance and sheltering during evacuations because of physical, mental, or sensory disabilities in registering with the appropriate local emergency management agency pursuant to s. 252.355.
(12) Each nurse registry shall prepare and maintain a comprehensive emergency management plan that is consistent with the criteria in this subsection and with the local special needs plan. The plan shall be updated annually. The plan shall include the means by which the nurse registry will continue to provide the same type and quantity of services to its patients who evacuate to special needs shelters which were being provided to those patients prior to evacuation. The plan shall specify how the nurse registry shall facilitate the provision of continuous care by persons referred for contract to persons who are registered pursuant to s. 252.355during an emergency that interrupts the provision of care or services in private residences. Nurse registries may establish links to local emergency operations centers to determine a mechanism by which to approach specific areas within a disaster area in order for a provider to reach its clients. Nurse registries shall demonstrate a good faith effort to comply with the requirements of this subsection by documenting attempts of staff to follow procedures outlined in the nurse registry’s comprehensive emergency management plan which support a finding that the provision of continuing care has been attempted for patients identified as needing care by the nurse registry and registered under s. 252.355 in the event of an emergency under this subsection.
(a) All persons referred for contract who care for persons registered pursuant to s. 252.355 must include in the patient record a description of how care will be continued during a disaster or emergency that interrupts the provision of care in the patient’s home. It shall be the responsibility of the person referred for contract to ensure that continuous care is provided.
(b) Each nurse registry shall maintain a current prioritized list of patients in private residences who are registered pursuant to s. 252.355 and are under the care of persons referred for contract and who need continued services during an emergency. This list shall indicate, for each patient, if the client is to be transported to a special needs shelter and if the patient is receiving skilled nursing services. Nurse registries shall make this list available to county health departments and to local emergency management agencies upon request.
(c) Each person referred for contract who is caring for a patient who is registered pursuant to s. 252.355shall provide a list of the patient’s medication and equipment needs to the nurse registry. Each person referred for contract shall make this information available to county health departments and to local emergency management agencies upon request.
(d) Each person referred for contract shall not be required to continue to provide care to patients in emergency situations that are beyond the person’s control and that make it impossible to provide services, such as when roads are impassable or when patients do not go to the location specified in their patient records.
(e) The comprehensive emergency management plan required by this subsection is subject to review and approval by the county health department. During its review, the county health department shall contact state and local health and medical stakeholders when necessary. The county health department shall complete its review to ensure that the plan complies with the criteria in the Agency for Health Care Administration rules within 90 days after receipt of the plan and shall either approve the plan or advise the nurse registry of necessary revisions. If a nurse registry fails to submit a plan or fails to submit requested information or revisions to the county health department within 30 days after written notification from the county health department, the county health department shall notify the Agency for Health Care Administration. The agency shall notify the nurse registry that its failure constitutes a deficiency, subject to a fine of $5,000 per occurrence. If the plan is not submitted, information is not provided, or revisions are not made as requested, the agency may impose the fine.
(f) The Agency for Health Care Administration shall adopt rules establishing minimum criteria for the comprehensive emergency management plan and plan updates required by this subsection, with the concurrence of the Department of Health and in consultation with the Division of Emergency Management.
(13) All persons referred for contract in private residences by a nurse registry must comply with the following requirements for a plan of treatment:
(a) When, in accordance with the privileges and restrictions imposed upon a nurse under part I of chapter 464, the delivery of care to a patient is under the direction or supervision of a physician or when a physician is responsible for the medical care of the patient, a medical plan of treatment must be established for each patient receiving care or treatment provided by a licensed nurse in the home. The original medical plan of treatment must be timely signed by the physician, physician assistant, or advanced registered nurse practitioner, acting within his or her respective scope of practice, and reviewed in consultation with the licensed nurse at least every 2 months. Any additional order or change in orders must be obtained from the physician, physician assistant, or advanced registered nurse practitioner and reduced to writing and timely signed by the physician, physician assistant, or advanced registered nurse practitioner. The delivery of care under a medical plan of treatment must be substantiated by the appropriate nursing notes or documentation made by the nurse in compliance with nursing practices established under part I of chapter 464.
(b) Whenever a medical plan of treatment is established for a patient, the initial medical plan of treatment, any amendment to the plan, additional order or change in orders, and copy of nursing notes must be filed in the office of the nurse registry.
(14) The nurse registry must comply with the notice requirements of s. 408.810(5), relating to abuse reporting.
(15)(a) The agency may deny, suspend, or revoke the license of a nurse registry and shall impose a fine of $5,000 against a nurse registry that:
1. Provides services to residents in an assisted living facility for which the nurse registry does not receive fair market value remuneration.
2. Provides staffing to an assisted living facility for which the nurse registry does not receive fair market value remuneration.
3. Fails to provide the agency, upon request, with copies of all contracts with assisted living facilities which were executed within the last 5 years.
4. Gives remuneration to a case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395 or this chapter and from whom the nurse registry receives referrals. A nurse registry is exempt from this subparagraph if it does not bill the Florida Medicaid program or the Medicare program or share a controlling interest with any entity licensed, registered, or certified under part II of chapter 408 that bills the Florida Medicaid program or the Medicare program.
5. Gives remuneration to a physician, a member of the physician’s office staff, or an immediate family member of the physician, and the nurse registry received a patient referral in the last 12 months from that physician or the physician’s office staff. A nurse registry is exempt from this subparagraph if it does not bill the Florida Medicaid program or the Medicare program or share a controlling interest with any entity licensed, registered, or certified under part II of chapter 408 that bills the Florida Medicaid program or the Medicare program.
(15)(b) The agency shall also impose an administrative fine of $15,000 if the nurse registry refers nurses, certified nursing assistants, home health aides, or other staff without charge to a facility licensed under chapter 429 in return for patient referrals from the facility.
(15)(c) The proceeds of all fines collected under this subsection shall be deposited into the Health Care Trust Fund.
(16) In addition to any other penalties imposed pursuant to this section or part, the agency may assess costs related to an investigation that results in a successful prosecution, excluding costs associated with an attorney’s time.
(17) The Agency for Health Care Administration shall adopt rules to implement this section and part II of chapter 408.
400.512 Screening of home health agency personnel; nurse registry personnel and contractors; and companions and homemakers.
The agency, registry, or service shall require level 2 background screening.
400.484 Right of inspection; deficiencies; fines.
(1) In addition to the requirements of s. 408.811, the agency may make such inspections and investigations as are necessary in order to determine the state of compliance with this part, part II of chapter 408, and applicable rules.
(2) The agency shall impose fines for various classes of deficiencies in accordance with the following schedule:
(a) A class I deficiency is any act, omission, or practice that results in a patient’s death, disablement, or permanent injury, or places a patient at imminent risk of death, disablement, or permanent injury. Upon finding a class I deficiency, the agency shall impose an administrative fine in the amount of $15,000 for each occurrence and each day that the deficiency exists.
(b) A class II deficiency is any act, omission, or practice that has a direct adverse effect on the health, safety, or security of a patient. Upon finding a class II deficiency, the agency shall impose an administrative fine in the amount of $5,000 for each occurrence and each day that the deficiency exists.
(c) A class III deficiency is any act, omission, or practice that has an indirect, adverse effect on the health, safety, or security of a patient. Upon finding an uncorrected or repeated class III deficiency, the agency shall impose an administrative fine not to exceed $1,000 for each occurrence and each day that the uncorrected or repeated deficiency exists.
(d) A class IV deficiency is any act, omission, or practice related to required reports, forms, or documents which does not have the potential of negatively affecting patients. These violations are of a type that the agency determines do not threaten the health, safety, or security of patients. Upon finding an uncorrected or repeated class IV deficiency, the agency shall impose an administrative fine not to exceed $500 for each occurrence and each day that the uncorrected or repeated deficiency exists.
(3) In addition to any other penalties imposed pursuant to this section or part, the agency may assess costs related to an investigation that results in a successful prosecution, excluding costs associated with an attorney’s time.
400.462 Definitions.—As used in this part, the term:
(1) “Administrator” means a direct employee, as defined in subsection (9), who is a licensed physician, physician assistant, or registered nurse licensed to practice in this state or an individual having at least 1 year of supervisory or administrative experience in home health care or in a facility licensed under chapter 395, under part II of this chapter, or under part I of chapter 429.
(2) “Admission” means a decision by the home health agency, during or after an evaluation visit to the patient’s home, that there is reasonable expectation that the patient’s medical, nursing, and social needs for skilled care can be adequately met by the agency in the patient’s place of residence. Admission includes completion of an agreement with the patient or the patient’s legal representative to provide home health services as required in s. 400.487(1).
(3) “Advanced registered nurse practitioner” means a person licensed in this state to practice professional nursing and certified in advanced or specialized nursing practice, as defined in s. 464.003.
(4) “Agency” means the Agency for Health Care Administration.
(5) “Certified nursing assistant” means any person who has been issued a certificate under part II of chapter 464.
(6) “Client” means an elderly, handicapped, or convalescent individual who receives companion services or homemaker services in the individual’s home or place of residence.
(7) “Companion” or “sitter” means a person who spends time with or cares for an elderly, handicapped, or convalescent individual and accompanies such individual on trips and outings and may prepare and serve meals to such individual. A companion may not provide hands-on personal care to a client.
(8) “Department” means the Department of Children and Family Services.
(9) “Direct employee” means an employee for whom one of the following entities pays withholding taxes: a home health agency; a management company that has a contract to manage the home health agency on a day-to-day basis; or an employee leasing company that has a contract with the home health agency to handle the payroll and payroll taxes for the home health agency.
(10) “Director of nursing” means a registered nurse who is a direct employee, as defined in subsection (9), of the agency and who is a graduate of an approved school of nursing and is licensed in this state; who has at least 1 year of supervisory experience as a registered nurse; and who is responsible for overseeing the professional nursing and home health aid delivery of services of the agency.
(11) “Fair market value” means the value in arms length transactions, consistent with the price that an asset would bring as the result of bona fide bargaining between well-informed buyers and sellers who are not otherwise in a position to generate business for the other party, or the compensation that would be included in a service agreement as the result of bona fide bargaining between well-informed parties to the agreement who are not otherwise in a position to generate business for the other party, on the date of acquisition of the asset or at the time of the service agreement.
(12) “Home health agency” means an organization that provides home health services and staffing services.
(13) “Home health agency personnel” means persons who are employed by or under contract with a home health agency and enter the home or place of residence of patients at any time in the course of their employment or contract.
(14) “Home health services” means health and medical services and medical supplies furnished by an organization to an individual in the individual’s home or place of residence. The term includes organizations that provide one or more of the following:
(a) Nursing care.
(b) Physical, occupational, respiratory, or speech therapy.
(c) Home health aide services.
(d) Dietetics and nutrition practice and nutrition counseling.
(e) Medical supplies, restricted to drugs and biologicals prescribed by a physician.
(15) “Home health aide” means a person who is trained or qualified, as provided by rule, and who provides hands-on personal care, performs simple procedures as an extension of therapy or nursing services, assists in ambulation or exercises, or assists in administering medications as permitted in rule and for which the person has received training established by the agency under s. 400.497(1).
(16) “Homemaker” means a person who performs household chores that include housekeeping, meal planning and preparation, shopping assistance, and routine household activities for an elderly, handicapped, or convalescent individual. A homemaker may not provide hands-on personal care to a client.
(17) “Home infusion therapy provider” means an organization that employs, contracts with, or refers a licensed professional who has received advanced training and experience in intravenous infusion therapy and who administers infusion therapy to a patient in the patient’s home or place of residence.
(18) “Home infusion therapy” means the administration of intravenous pharmacological or nutritional products to a patient in his or her home.
(19) “Immediate family member” means a husband or wife; a birth or adoptive parent, child, or sibling; a stepparent, stepchild, stepbrother, or stepsister; a father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; a grandparent or grandchild; or a spouse of a grandparent or grandchild.
(20) “Medical director” means a physician who is a volunteer with, or who receives remuneration from, a home health agency.
(21) “Nurse registry” means any person that procures, offers, promises, or attempts to secure health-care-related contracts for registered nurses, licensed practical nurses, certified nursing assistants, home health aides, companions, or homemakers, who are compensated by fees as independent contractors, including, but not limited to, contracts for the provision of services to patients and contracts to provide private duty or staffing services to health care facilities licensed under chapter 395, this chapter, or chapter 429 or other business entities.
(22) “Organization” means a corporation, government or governmental subdivision or agency, partnership or association, or any other legal or commercial entity, any of which involve more than one health care professional discipline; a health care professional and a home health aide or certified nursing assistant; more than one home health aide; more than one certified nursing assistant; or a home health aide and a certified nursing assistant. The term does not include an entity that provides services using only volunteers or only individuals related by blood or marriage to the patient or client.
(23) “Patient” means any person who receives home health services in his or her home or place of residence.
(24) “Personal care” means assistance to a patient in the activities of daily living, such as dressing, bathing, eating, or personal hygiene, and assistance in physical transfer, ambulation, and in administering medications as permitted by rule.
(25) “Physician” means a person licensed under chapter 458, chapter 459, chapter 460, or chapter 461.
(26) “Physician assistant” means a person who is a graduate of an approved program or its equivalent, or meets standards approved by the boards, and is licensed to perform medical services delegated by the supervising physician, as defined in s. 458.347 or s. 459.022.
(27) “Remuneration” means any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind.
(28) “Skilled care” means nursing services or therapeutic services required by law to be delivered by a health care professional who is licensed under part I of chapter 464; part I, part III, or part V of chapter 468; or chapter 486 and who is employed by or under contract with a licensed home health agency or is referred by a licensed nurse registry.
(29) “Staffing services” means services provided to a health care facility, school, or other business entity on a temporary or school-year basis pursuant to a written contract by licensed health care personnel and by certified nursing assistants and home health aides who are employed by, or work under the auspices of, a licensed home health agency or who are registered with a licensed nurse registry.
400.488 Assistance with self-administration of medication.
**Abby Services does not promote or encourage assistance with self-administration of medications for liability reasons. We recommend “Medication Reminders” only as directed by a client’s family, caregiver, and/or physician.**
(1) For purposes of this section, the term:
(a) “Informed consent” means advising the patient, or the patient’s surrogate, guardian, or attorney in fact, that the patient may be receiving assistance with self-administration of medication from an unlicensed person.
(b) “Unlicensed person” means an individual not currently licensed to practice nursing or medicine who is employed by or under contract to a home health agency and who has received training with respect to assisting with the self-administration of medication as provided by agency rule.
(2) Patients who are capable of self-administering their own medications without assistance shall be encouraged and allowed to do so. However, an unlicensed person may, consistent with a dispensed prescription’s label or the package directions of an over-the-counter medication, assist a patient whose condition is medically stable with the self-administration of routine, regularly scheduled medications that are intended to be self-administered. Assistance with self-medication by an unlicensed person may occur only upon a documented request by, and the written informed consent of, a patient or the patient’s surrogate, guardian, or attorney in fact. For purposes of this section, self-administered medications include both prescribed and over-the-counter oral dosage forms, topical dosage forms, and topical ophthalmic, otic, and nasal dosage forms, including solutions, suspensions, sprays, and inhalers.
(3) Assistance with self-administration of medication includes:
(a)Taking the medication, in its previously dispensed, properly labeled container, from where it is stored and bringing it to the patient.
(b)In the presence of the patient, reading the label, opening the container, removing a prescribed amount of medication from the container, and closing the container.
(c)Placing an oral dosage in the patient’s hand or placing the dosage in another container and helping the patient lift the container to his or her mouth.
(d) Applying topical medications.
(e) Returning the medication container to proper storage.
(f) Keeping a record of when a patient receives assistance with self-administration under this section.
(4) Assistance with self-administration does not include:
(a) Mixing, compounding, converting, or calculating medication doses, except for measuring a prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed.
(b) The preparation of syringes for injection or the administration of medications by any injectable route.
(c) Administration of medications through intermittent positive pressure breathing machines or a nebulizer.
(d) Administration of medications by way of a tube inserted in a cavity of the body.
(e) Administration of parenteral preparations.
(f) Irrigations or debriding agents used in the treatment of a skin condition.
(g) Rectal, urethral, or vaginal preparations.
(h) Medications ordered by the physician or health care professional with prescriptive authority to be given “as needed,” unless the order is written with specific parameters that preclude independent judgment on the part of the unlicensed person, and at the request of a competent patient.
(i) Medications for which the time of administration, the amount, the strength of dosage, the method of administration, or the reason for administration requires judgment or discretion on the part of the unlicensed person.
(5) Assistance with the self-administration of medication by an unlicensed person as described in this section does not constitute administration as defined in s. 465.003.
(6) The agency may by rule establish procedures and interpret terms as necessary to administer this section.
408.810(5)(a) Minimum licensure requirements On or before the first day services are provided to a client, a licensee must inform the client and his or her immediate family or representative, if appropriate, of the right to report:
1. Complaints. The statewide toll-free telephone number for reporting complaints to the agency must be provided to clients in a manner that is clearly legible and must include the words: “To report a complaint regarding the services you receive, please call toll-free (1-888-419-3456).”
2. Abusive, neglectful, or exploitative practices. The statewide toll-free telephone number for the central abuse hotline must be provided to clients in a manner that is clearly legible and must include the words: “To report abuse, neglect, or exploitation, please call toll-free (1-800-962-2873).”
3. Medicaid fraud. An agency-written description of Medicaid fraud and the statewide toll-free telephone number for the central Medicaid fraud hotline must be provided to clients in a manner that is clearly legible and must include the words: “To report suspected Medicaid fraud, please call toll-free (1-866-7226).”
Alzheimer’s disease (AD) is the most common form for dementia (a brain disorder that seriously affects a person’s ability to carry out daily activities) among older people. It involves the parts of the brain that control thought, memory and language. Everyday scientists learn more but right now the causes and cure of AD are still unknown.
AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today these plaques and tangles in the brain are considered hallmarks of AD. Scientists also have found other brain changes in people with AD. There is a loss of nerve cells in areas of the brain that are vital to memory and other mental abilities. There also are lower levels of chemicals in the brain that carry complex messages back and forth between nerve cells. AD may disrupt normal thinking and memory by blocking these messages between nerve cells.
What is Dementia? The term “dementia” describes a group of symptoms that are caused by changes in brain function. Dementia symptoms may include asking the same questions repeatedly; becoming lost in familiar places; and neglecting personal safety, hygiene, and nutrition. People with dementia lose their abilities at different rates.
Dementia is caused by many conditions. Some conditions that cause dementia can be reversed, and others cannot. The two most common forms of dementia in older people are Alzheimer’s disease and multi-infarct dementia (sometimes called vascular dementia). These types of dementia are irreversible, which means they cannot be cured
Reversible conditions with symptoms of dementia can be caused by a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicine, problems with the thyroid gland, or a minor head injury. Medical conditions like these can be serious and should be treated by a doctor ASAP.
Sometimes older people have emotional problems that can be mistaken for dementia. Feeling sad, lonely, worried, or bored may be more common for older people facing retirement or coping with the death of a spouse, relative, or friend. Emotional problems can be eased by supportive friends and family, or by professional help from a doctor.
Caring for a person with Alzheimer’s disease (AD) at home is a difficult task and can become overwhelming at times. Each day brings new challenges as the caregiver copes with changing levels of ability and new patterns of behavior.
Communication Trying to communicate with a person who has AD can be a challenge. Both understanding and being understood may be difficult.
Bathing While some people with AD don’t mind bathing, for others it is a frightening, confusing experience. Advanced planning can help make bath time better for both of you.
Dressing For someone who has AD, getting dressed presents a series of challenges: choosing what to wear getting some clothes off and other clothes on, and struggling with buttons and zippers. Minimize the challenges may make a difference.
Eating Eating can be a challenge. Some people with AD want to eat all the time, while others have to be encouraged to maintain a good diet.
Exercise Incorporating exercise into the daily routine has benefits for both the person with AD and the caregiver. Not only can it improve health, but also can provide a meaningful activity for both of you to share.
Incontinence As the disease progresses, many people with AD begin to experience incontinence, or the inability to control their bladder and/or bowels. Incontinence can be upsetting to the person and difficult for the caregiver. Sometimes incontinence is due to physical illness, or be sure to discuss it with the person’s doctor.
Sleep Problems For the exhausted caregiver, sleep can’t come too soon. For many people with AD, however, nighttime maybe a difficult time. Getting the person to go to bed and stay there may require some advance planning.
Hallucinations and Delusions As the disease progresses, a person with AD may experience hallucinations and/or delusions. Hallucinations are when the person sees, hears, smells, tastes, or feels something that is not there. Delusions are false beliefs from which the person cannot be dissuaded.
Wandering Keeping the person safe is one of the most important aspects of care giving. Some people with Ad have a tendency to wander away from their home or their caregiver. Knowing what to do limit wandering can protect a person from becoming lost.
Home Safety Caregivers of people with AD often have to look at their homes through new eyes to identify and correct safety risks. Creating a safe environment can prevent many stressful and dangerous situations.
Comprehensive Emergency Management Plan per Florida Administrative Code 59A-18.018
What is an emergency? An emergency is an unforeseen combination of circumstances that calls for immediate action. Abby Services Inc.’s Comprehensive Emergency Management Plan may be initiated for a locally declared natural disaster such as a flood, earthquake, hurricane, tornado, etc, a civil defense disaster such as a war, poisonous gas, nuclear accident, or a community emergency such as a strike, transportation accident, or prolonged power failure.
Roles and Responsibilities of:
Management-The Administrator of ASI will monitor appropriate media outlets including internet, radio, and tv, to determine when to activate the plan. All office staff will be on call during and after the event to make a good faith effort to provide services of the same type and quantity during an emergency.
Independent Contractor– Those serving patients with special needs are responsible for maintaining a list of patient specific medications, supplies, and equipment required for continuing care, as services should the patient be evacuated. The patient will need to take with them a list including their diagnosis, the names of all medications, their dose, frequency, route, time of day and any special considerations for administration. The list must also include any allergies; the name of the patient’s physician and the physician’s phone number; and the name, phone number and address of the patient’s pharmacy. You are responsible for reviewing with clients registered with a special needs shelter Appendix B of the Emergency plan. Independent contractors, if they choose, can work with the local, county, or state agency, to staff special needs shelters during the emergency by contacting the county disaster coordinator or the county department of health. All caregivers are expected make a good faith effort to provide services of the same type and quantity during an emergency however, Per FS 400.506(12)(d) Each person referred for contract shall not be required to continue to provide care to patients in emergency situations that are beyond the person’s control and that make it impossible to provide services.
Patient/Client– All clients requiring assistance during an emergency are encouraged to evacuate to a shelter with around the clock care in place before during and after an emergency. Clients upon admission and annually thereafter are advised of the county special needs registry for possible sheltering during a declared emergency, and will be asked to identify their evacuation plan should services be disrupted. Abby Services will assist local emergency management by collecting special needs registration information as part of the admission. Patients who wish to register with the special needs registry will be assisted with registration if desired and provided with Appendix B: Information for the patient. Patients or clients who are not eligible for the Special Health Needs Program or wish not to participate, are responsible for their own personal arrangements should evacuation be warranted. Abby Services will assist with plans when requested and will document in the patient’s file their desire to evacuate or remain at home.
OSHA-As an IC, you are responsible for being familiar with OSHA Right to Know/Hazardous Communication and Blood borne Pathogen Standards.
Hepatitis B Vaccine Declination- Due to my occupational exposure to blood or blood borne pathogen, I may be at risk of acquiring a Hepatitis B Virus (HBV) infection. I have been informed by Abby Services Inc. that I should be vaccinated with Hepatitis Vaccine. However, I decline Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or blood borne infectious materials and I want to be vaccinated with Hepatitis B vaccine, I will acquire it at that time.
RIGHT TO KNOW/HAZARD COMMUNICATION-At any facility to which you are referred, you have the right to have access to and to review information relating to the facilities’ policies including: Existence and requirements of the hazard communication standard, Components, location, and implementation of the right to know standard, Areas where chemicals area safely stored, properly labeled, and with access to material safety data sheets on all chemicals, Lists of chemicals by department, Physical and health hazards of chemicals used throughout the facility, Protective measures.
Privacy Policies from the Florida Department of Law Enforcement and the Federal Bureau of Investigation
FLORIDA DEPARTMENT OF LAW ENFORCEMENT
NOTICE FOR APPLICANTS SUBMITTING FINGERPRINTS WHERE CRIMINAL RECORD RESULTS WILL BECOME PART OF THE CARE PROVIDER BACKGROUND SCREENING CLEARINGHOUSE
This notice is to inform you that when you submit a set of fingerprints to the Florida Department of Law Enforcement (FDLE) for the purpose of conducting a search for any Florida and national criminal history records that may pertain to you, the results of that search will be returned to the Care Provider Background Screening Clearinghouse. By submitting fingerprints, you are authorizing the dissemination of any state and national criminal history record that may pertain to you to the Specified Agency or Agencies from which you are seeking approval to be employed, licensed, work under contract, or to serve as a volunteer, pursuant to the National Child Protection Act of 1993, as amended, and Section 943.0542, Florida Statutes. “Specified agency” means the Department of Health, the Department of Children and Family Services, the Division of Vocational Rehabilitation within the Department of Education, the Agency for Health Care Administration, the Department of Elder Affairs, the Department of Juvenile Justice, and the Agency for Persons with Disabilities when these agencies are conducting state and national criminal history background screening on persons who provide care for children or persons who are elderly or disabled. The fingerprints submitted will be retained by FDLE and the Clearinghouse will be notified if FDLE receives Florida arrest information on you.
Your Social Security Number (SSN) is needed to keep records accurate because other people may have the same name and birth date. Disclosure of your SSN is imperative for the performance of the Clearinghouse agencies’ duties in distinguishing your identity from that of other persons whose identification information may be the same as or similar to yours.
Licensing and employing agencies are allowed to release a copy of the state and national criminal record information to a person who requests a copy of his or her own record if the identification of the record was based on submission of the person’s fingerprints. Therefore, if you wish to review your record, you may request that the agency that is screening the record provide you with a copy. After you have reviewed the criminal history record, if you believe it is incomplete or inaccurate, you may conduct a personal review as provided in s. 943.056, F.S., and Rule 11C8.001, F.A.C. If national information is believed to be in error, the FBI should be contacted at 304-625-2000. You can receive any national criminal history record that may pertain to you directly from the FBI, pursuant to 28 CFR Sections 16.30-16.34. You have the right to obtain a prompt determination as to the validity of your challenge before a final decision is made about your status as an employee, volunteer, contractor, or subcontractor.
Until the criminal history background check is completed, you may be denied unsupervised access to children, the elderly, or persons with disabilities.
The FBI’s Privacy Statement follows on a separate page and contains additional information.
FBI Privacy Statement
Authority: The FBI’s acquisition, preservation, and exchange of information requested by this form is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include numerous Federal statutes, hundreds of State statutes pursuant to Pub.L. 92-544, other authorized authorities. Examples include, but are not limited to: 5 U.S.C. 9101; Pub.L. 94-29; Pub.L. 101-604; and Executive Orders 10450 and 12968. Providing the requested information is voluntary; however, failure to furnish the information may affect timely completion or approval of your application.
Social Security Account Number (SSAN). Your SSAN is needed to keep records accurate because other people may have the same name and birth date. Pursuant to the Federal Privacy Act of 1974 (5USC 552a), the requesting agency is responsible for informing you whether disclosure is mandatory or voluntary, by what statutory of other authority you SSAN is solicited, and what uses will be made of it. Executive Order 9397 also asks Federal agencies to use this number to help identify individuals in agency records.
Principal Purpose: Certain determinations, such as employment, security, licensing, and adoption, may be predicated on fingerprint based checks. Your fingerprints and other information contained on (and along with) this form may be submitted to the requesting agency, the agency conducting the application investigation, and/or FBI for the purpose of comparing the submitted information to available records in order to identify other information that may be pertinent to the application. During the processing of this application, and for as long hereafter as may be relevant to the activity for which this application is being submitted, the FBI may disclose any potentially pertinent information to the requesting agency and/or to the agency conducting the investigation. The FBI may also retain the submitted information in the FBI’s permanent collection of fingerprints and related information, where it will be subject to comparisons against other submissions received by the FBI. Depending on the nature of your application, the requesting agency and/or the agency conducting the application investigation may also retain the fingerprints and other submitted information for other authorized purpose of such agency(ies).
Routine Uses: The fingerprints and information reported on this form may be disclosed pursuant to your consent, and may also be disclosed by the FBI without your consent as permitted by the Federal Privacy Act of 1974 (5 USC 552a(b)) and all applicable routine uses as may be published at any time in the Federal Register, including the routine uses for the FBI Fingerprint Identification Records System (Justice/FBI-009) and the FBI’s Blanket Routine Uses (Justice/FBI-BRU). Routine uses include, but are not limited to, counterintelligence, national security or public safety matters to which the information may be relevant; to State and local governmental agencies and nongovernmental entities for application processing as authorized by Federal and State legislation, executive order, or regulation, including employment, security, licensing, and adoption checks; and as otherwise authorized by law, treaty, executive order, regulation, or other lawful authority. If other agencies are involved in processing this application, the may have additional routine uses.
Additional Information: The requesting agency and/or the agency conducting the application investigation will provide you additional information pertinent to the specific circumstances of this application, which may include identification of other authorities, purposes, uses, and consequences of not providing requested information. In addition, any such agency in the Federal Executive Branch has also published notice.