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Emergency Plan - Matrix Home Care

Emergency plan Patient / Client Information Emergency Phone Numbers Patient / Client Name Police, Ambulance, Fire Phone # Primary Physician Name 911. Phone #. Street Address Matrix home Care 24-Hour Phone # Pharmacy Name Address: Safety Liaison: Administrator Phone #. City Medical / Respiratory Equipment Emergency Contact Person Name 24-hour Phone #. State: Florida Relationship: Zip Code: Phone #. Telephone # Poison Control Phone # Neighbor/Friend Name 1-800-222-1222. Phone #. Disaster Priority Level (check one): Low Moderate High Reporting Abuse/Neglect Florida law now requires all home health agencies to inform patients and immediate family, if appropriate, of their right to report abusive, neglectful, or exploitative practices.

Emergency Plan Patient / Client Information E mergency Phone Nu bers Patient / Client Name Street Address City Telephone # Police, Ambulance, Fire Phone # Matrix Home Care 24-Hour Phone #

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Transcription of Emergency Plan - Matrix Home Care

1 Emergency plan Patient / Client Information Emergency Phone Numbers Patient / Client Name Police, Ambulance, Fire Phone # Primary Physician Name 911. Phone #. Street Address Matrix home Care 24-Hour Phone # Pharmacy Name Address: Safety Liaison: Administrator Phone #. City Medical / Respiratory Equipment Emergency Contact Person Name 24-hour Phone #. State: Florida Relationship: Zip Code: Phone #. Telephone # Poison Control Phone # Neighbor/Friend Name 1-800-222-1222. Phone #. Disaster Priority Level (check one): Low Moderate High Reporting Abuse/Neglect Florida law now requires all home health agencies to inform patients and immediate family, if appropriate, of their right to report abusive, neglectful, or exploitative practices.

2 This abuse may be physical, mental, emotional, or financial in nature. At Matrix home Care our concern is the well being of our patients, as well as the community at large. To report abuse, neglect, or exploitation please call toll free 1-800-962-2873 Abuse Hotline Medicaid Fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person. It includes any act that constitutes fraud under applicable federal or state law as it relates to Medicaid.

3 To Report Suspected Medicaid Fraud call toll-free 1-888-419-3456. To report a complaint regarding the services you receive, please call toll free: 1-888-419-3456. 5/13 WHITE - Clinical Record YELLOW - Patient Copy Page 1 of 1.


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