Orange County NC Website
Browse       Search
ORANGE COUNTY ELDERLI CHORE PROGRAM <br />PROVIDER AGREEMENT <br />This is to certify that Personalized Patient Home Assistance <br />( Name of Agency) <br />herein after known as the Provider agency, located at <br />109 Concord Drive, Chapel Hill, N. C. 27514 <br />(Address) <br />on this _ first day of July, 1990 <br />agrees to participate as a provider in the Orange County Elderly <br />Program for the period July 1, 1990 through June 30, 1991. <br />1. The Provider agency agrees to provide necessary Chore servvice <br />to approved recipients at $ 8.00 per hour upon the request <br />of the Orange County Department on Aging's Care Management <br />Program hereinafter known as the lead Administrative <br />Aency. <br />2. The Provider agency agrees to meet all service provision <br />standards for Chore such as training as required by the <br />State of North Carolina and provide documentation upon request. <br />(Attachment A) v <br />3. The provider agency agrees to provide the Chore service <br />within two weeks from the beginning service date specified in the <br />Purchase of Service Authorization on each approved recipient. <br />(Attachment B) <br />4. The provider agency agrees to ensure that such records as <br />necessary are kept to fully disclose the extent of the service <br />provided to recipients for four years and available for <br />inspection. <br />5. The Provider agency agrees to submit a monthly bill for services <br />rendered payable within 30 days from date of receipt. <br />6. The Provider agency agrees to adhere to the Inter - agency Long Term <br />Care Management Procedures in the provision of the service. <br />(Attachment C) <br />7. This agreement may be terminated by Orange County upon giving <br />30 days prior written notice or by the Provider agency upon <br />giving 30 days prior written notice. However, Orange County <br />may immediately suspend a provider agency for violations of the <br />rules or regul tions that govern the program or this agreement. <br />Lead A s N e ProX�ct�) By : Bv: . <br />Sig ature of Auth ed Agent Signature of Age �KV <br />Title of Au orize Agent Title 6f Auth ized Aa nt <br />Date: / 'fl) Date: <br />y �s �� <br />FN:PROVIDEF.DOC <br />