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ORANGE COUNTY ELDERLY RESPITE HOME CARE <br />PROVIDER AGREEMENT <br />PR 1 m & 14ML7 -H, x,vc. d w <br />This is to certify that Health Force Professional Health Care People <br />(Name of Agency) <br />herein after known as the Provider agency, located at <br />Suite C 4001 Barrett Road ess) h N. C. 27609 <br />(Address) <br />on this 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 Repite service <br />to approved recipients at $9.00 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 Respite such as training as required by the <br />State of North Carolina and provide documentation upon request. <br />(Attachment A) <br />3. The provider agency agrees to provide the Respite 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 <br />necessary are kept to fully <br />provided to recipients for <br />inspection. <br />to ensure that such records as <br />disclose the extent of the service <br />four years and available for <br />5. The Provider agency agrees to submit a monthly bill for services <br />rendered payable within 30 days from date of receipt. <br />L"'Pul, <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 regulations that govern the program or this agreement. <br />Leaftd,AP6 &I 8t rati <br />By: <br />Signature of Author <br />Title 6f Authorized agent <br />Date: <br />FN:PROVIDER.DOC <br />Provider gene <br />By: <br />Agent Signature of Agen <br />J&CC7 <br />Title of Authorized Agent <br />Date: vZ If a <br />