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ORANGE COUNTY ELDERLY CHORE PROGRAM <br />PROVIDER AGREEMENT 2 <br />This is to certify that The Ri ht Staff, Inc. <br />( Name of Provider agency) <br />hereinafter known as the Provider agency, located at FORM <br />P.O. Box 1613. <br />Cho 1 Hill, <br />(address) (Sample) <br />on 'this 4th day of Dec�nber, 19$9 <br />agrees to participate as a <br />Elderly Chore Program for the Period in the Orange County <br />June 30, 1990, period October 1, 1989 through <br />1. The Provider agency agrees to <br />d <br />service to approved recipients patva $ necessary Chore <br />service hour upon the request of $$.00 per direct <br />Department on Aging's Care Management Orange <br />hereinafter <br />known as the Lead Administrative Agency. <br />2. The Provider agency agrees to meet all service <br />standards such as training as required b Provision <br />North Carolina and provide docum Y the State of <br />(Attachment A) entation upon request. <br />3. The Provider agency agrees to '�', <br />within two weeks from the beginningdserviicehdatesspeiif <br />in the Purchase of Service Authorization on each pacified <br />approved recipient. (Attachment B) <br />4. The Provider agency agrees to <br />minimum training if the recipient''sdconditiorn isrjud with above <br />Lead Administrative Agency to require it. Judged by the <br />5. The Provider agency agrees to ensure that such r <br />necessary are kept to fully di hat records as <br />ose the extent a Of the <br />service provided to recipients for four years and <br />available for inspection. <br />6. The Provider agency agrees to submit a monthly bill fo <br />services rendered payable within 30 days from date of r <br />receipt, <br />7. The Provider agency agrees to adhere to the Inter -a enc <br />Long Term Care Management Procedures in the g y <br />Elderly Chore Service. (Attachment C) Provision of <br />S. This agreement may be terminated by Orange County upon <br />giving 30 days prior written notice or b y the Provider <br />agency upon giving 30 days prior written notice- However, <br />Orange County may immediately suspend a <br />for violations of the rules or regulationsothatr agency <br />program or this agreement. govern the <br />Lead Administrative Agency <br />By: Provider Agency <br />Signature of Authorized Agent By. <br />Signature of Agent <br />Title of Authorized Agent <br />Date: Title of Authorized Agent <br />M CHORAGRE.DOC Dater <br />