Employee Onboarding | Proxima Home Health Care

Employee information

Confirm your current contact and emergency information.

Full legal name *

Phone *

Home address *

Emergency contact *

Relationship

Emergency phone *

Orientation and service-plan training

Orientation covers Proxima's mission, services, patient rights, emergency preparedness, infection control, incident reporting, abuse prevention, documentation, cultural awareness, QAPI, professional boundaries, and role-specific responsibilities.

I reviewed Proxima's mission, services, organizational responsibilities, and patient charges. I reviewed patient rights, responsibilities, advance directives, complaints, grievances, ethics, and cultural awareness. I completed home-safety, emergency-preparedness, unsafe-situation, and incident-reporting training. I completed OSHA, standard precautions, infection-control, and TB education. I completed abuse, neglect, exploitation, fraud, False Claims, and whistleblower reporting training. I reviewed documentation, recordkeeping, confidentiality, electronic signatures, supervision, and evaluation requirements. I reviewed QAPI, patient-centered care, dementia and developmental-disability support, and professional boundaries. I completed service-plan training and understand that I must review updates before providing changed services.

I attest that I completed the orientation and service-plan training items listed above. *

Compliance, confidentiality, and conduct

I will protect patient information, use only authorized systems, follow Proxima policies, report suspected fraud, abuse, neglect, safety concerns, privacy incidents, and conflicts of interest, and never share passwords or electronic signature credentials.

Complete before acknowledging

Review Proxima's confidentiality, HIPAA, corporate-compliance, incident-reporting, electronic-signature, password-security, conflict-of-interest, and professional-conduct requirements.

If you suspect unauthorized access to patient information, must you report it promptly? *

May you share your EVV, clinical-system, or portal password with another employee? *

Must suspected fraud, abuse, neglect, exploitation, or unsafe care be reported? *

May patient information be accessed when it is not needed for your assigned work? *

I attest that I reviewed and completed Proxima's compliance, confidentiality, privacy, and conduct training. *

Employee handbook

I acknowledge responsibility for reading and following the current Proxima Employee Handbook. The handbook does not create a guarantee of employment for a fixed term, and policy changes will be communicated by Proxima.

Read Employee Handbook I attest that I received and reviewed the Proxima Employee Handbook and understand my responsibility to follow current policies. *

Role responsibilities

I reviewed the duties, supervision, documentation, safety, attendance, and professional-boundary requirements for my role. I asked questions or confirmed that I do not have unanswered questions about my role.

I attest that I completed my job-description review and understand that I must work only within my assigned role, qualifications, supervision, and plan of care. *

Active license, certification, or credential number

Expiration date

HHA competency and EVV

HHA onboarding includes competency validation for personal care, infection prevention, safety, transfers, nutrition, observation and reporting, emergencies, abuse prevention, service-plan compliance, EVV clock-in/out, missed-visit reporting, and field documentation.

Primary EVV method *

Backup EVV method

Must a missed clock-in, clock-out, shift, schedule change, time change, or service-location change be reported promptly? *

May an HHA administer medication? *

Must care follow the current patient plan of care? *

Must incidents, changes in condition, abuse concerns, and unsafe situations be reported? *

I attest that I completed EVV training and understand how to record and correct visits using the method selected above. I understand that employer observation and competency sign-off must be completed before any assignment requiring that validation.

Health and TB documentation

Complete the baseline risk and symptom questions from the supplied TB packet. These answers are sensitive employment-health information. Supporting clinician records must be provided only through Proxima's designated secure process.

Residence for at least one month in a country with a high TB rate? *

Current or planned immunosuppression? *

Close contact with someone with infectious TB since your last test? *

Previous positive TB test or history of TB infection? *

Previously received BCG vaccine? *

Prolonged or recurring fever? *

Recent unexplained weight loss? *

Chronic cough? *

Coughing up blood? *

Night sweats? *

Silicosis or another qualifying chronic lung condition? *

History of gastrectomy? *

History of intestinal bypass? *

Weight at least 10% below ideal body weight? *

Chronic renal disease? *

Diabetes mellitus? *

Prolonged high-dose corticosteroid or other immunosuppressive therapy? *

Hematologic disorder such as leukemia or lymphoma? *

Known HIV exposure or HIV/AIDS diagnosis? *

Other malignancy? *

Has the required clinician health statement or fitness documentation been completed? *

Hepatitis B vaccination decision *

Documentation status

I attest that I completed the health and TB questions accurately and will provide supporting records through the designated secure process. *

Official employment and payroll forms

Complete the current official Form I-9 and Form W-4 through Proxima's designated secure process. Banking information and identity documents are not collected in this prototype portal.

Official USCIS Form I-9 Official IRS Form W-4

Form I-9 status *

Form W-4 status *

Direct-deposit status *

Employee ID receipt *

I attest that I reviewed the official-form requirements and recorded my current completion status above. *

Certification and electronic signature

I certify that the information provided is accurate and that my electronic signature represents my acknowledgment of the selected onboarding items.

Electronic signature *

Date *

Complete your Proxima onboarding