• I understand that it's against the New York State CDPAP regulations to work as a Personal Assistant in the MEADOWS HOME CARE CDPAP if I am a spouse of the Consumer (Patient).
• I am at least 18 years old.
• I agree to complete a pre-employment physical examination before I begin work, then annually.
• I am not the Designated Representative of the Consumer (Patient) enrolled in the MEADOWS HOME CARE AGENCY, CDPAP
• I am not an employee of MEADOWS HOME CARE AGENCY CDPAP, agent or affiliated individual.
• I understand that I must inform MEADOWS HOME CARE if my relationship with the Consumer (Patient) changes.
• I understand that I must not work for a Consumer (Patient) who is in the Hospital or Nursing Home or other health related facility other than the Consumer's (Patient's) home.

I have read all the above statements, and I will comply with these requirements. I also understand that failure to abide by the rules stated above could be considered Medicaid Fraud and could subject me to investigation and possible criminal prosecution by the Office of the Attorney General Medicaid Fraud Control unit, and the Medicaid Inspector General.