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5617 NW 7TH ST. MIAMI FL 33126-3216

Essential Caregiver Acknowledgement

EXHIBIT C

    I,

    Accept the designation as an essential caregiver for

    I understand that:
    • My visits as an essential caregiver are subject to Residential Plaza’s infection control and education policies and procedures. I acknowledge receiving the policies and procedures and agree to always abide by them.
    • Essential caregiver visits cannot occur if the resident personally objects/declines your visit no matter the circumstance per 408.823 of F.S. “(c) The visitation policies and procedures required by this section must allow in-person visitation in all the following circumstances, unless the resident, client, or patient objects: 1. End-of-life situations. 2. A resident who was living with family before being admitted to the provider’s care is struggling with the change in environment and lack of in-person family support. 3. The resident is making one or more major medical decisions. 4. A resident is experiencing emotional distress or grieving the loss of a friend or family member who recently died. 5. A resident needs cueing or encouragement to eat or drink which was previously provided by a family member or caregiver. 6. A resident who used to talk and interact with others is seldom speaking. “
    • When visiting as an essential caregiver, I will utilize personal protective equipment (PPE) as determined by facility policies and procedures.
    • I acknowledge having received training on infection prevention and control, use of PPE, use of masks, hand sanitation, and social distancing. I am satisfied with the training provided and do not have any questions regarding any of these topics.
    • I acknowledge my obligation and agree to immediately notify Residential Plaza if I experience symptoms of a respiratory infection, cough, fever, shortness of breath or difficulty breathing, congestion or runny nose, sore throat, chills, headache, muscle pain, repeated shaking with chills, new loss of taste or smell, nausea or vomiting, diarrhea, symptoms possibly related to a contagious infection, or if I test positive for an infection/ communicable disease (including but not limited to COVID-19) within fourteen (14) days of a visit.
    • Visits by essential caregivers may be restricted or revoked for failure to follow infection prevention and control procedures of Residential Plaza.