Health Information Management Team Onboarding Packet

Welcome to theDetroit Medical CenterTo Our NewHealth Information ManagementTeamOnboarding PacketQuestions?Contact your manager/director orJanet Hash (313) 578-2368Athena Hinojosa (313) 578-39894/2/12 Employment1

Welcome to Detroit Medical CenterHealth Information Management TeamFor complete information go to www.dmc.org/himdeptonboardingAgain, congratulations on your offer and acceptance of employment with the Detroit MedicalCenter. We look forward to having you join the DMC team. This package gives you more detailabout the Employment process.EMPLOYMENT PROCESS STEPS1. Contact your site Occupational Health Services Department toschedule your physical.Midtown:(313) 966-0733 – Renee LeclercSinai-Grace: (313) 966-4807Huron Valley-Sinai: (248) 937-34052. Complete all paperwork in the attached packet and bring to HumanResources meeting at your site. Bring all required documents as well.This includes evidence of all education and credentials required foryour job. Also, ensure that all your education, training, workexperience and credentials are completely and accurately reflected onthe application, as this will be used to verify you meet the minimumqualifications for your position.Review the Compliance Manual that your supervisor will give to you,and sign the Certification Form in the forms packet.DEADLINE4/13Now – 5/103. Attend a Human Resources Onboarding session (See schedule). 4/17–5/34. Complete NetLearning (online required training modules). See yourManager for your employee number.5. Complete all parts of the Pre-Employment Physical, as the physicalmay require you to visit OHS more than once.6. Schedule a call with a Benefits Counselor. See Onboarding webpage for details.5/105/165/17– 5/247. Complete your scheduled call with a Benefits Counselor. 5/22–5/318. Your ID badge form will be given to you by your manager. You are toget your badge the week you get the form.9. Attend System New Employment Orientation – your director willschedule you for a session. The HIM team will attend in small groupsin June–September.5/30June – Sept.Complete as many forms as possible prior to your site HR meeting. If you have questionsbefore your site meeting call (313) 578-3185.[ REMOTE STAFF also see next page ]2

ON-SITE HIM DEPARTMENTHUMAN RESOURCES NEW EMPLOYEE ONBOARDING SESSIONOn these dates / times, our DMC Human Resources staff will be on-site in your HIM departmentmeeting room to review and collect all of your new employee paperwork and copy requireddocuments.You must either attend ONE of these sessions --- or present to the Midtown HR ServiceCenter - Orchestra Place or your site (SG, DSH or HVSH) HR Service Center during normalbusiness hours.Children’s4/17, 6-8:30am4/25, 4-6pmSinai-Grace4/19, 6-8:30am4/24, 4-6pmHarper5/2, 6-8:30am4/26, 4-6pmold Hutzel5/1, 6-8:30am5/3, 4-6pmStaff at Detroit Receiving are asked to plan to come to one of the above session, as it works fortheir schedule, or to Orchestra Place (Midtown Campus) between 8a - 4:30p M-F.REMOTE STAFFIf you will be traveling to a DMC campus for your on-boarding –If you live within a reasonable distance of a DMC campus, we ask that you come on-campus for aday to complete your drug screen (indicate “drug screen only” when scheduling OHSappointment) and HR On-boarding session.If you will be completing your on-boarding remote –If you do NOT live within a reasonable distance of a DMC campus, you will complete your onboardingremote, and you will need to complete the following steps:• Contact Athena Hinojosa, ahinojos@dmc.org, 313/578-3989, for a remote drug screenreferral.• Secure the services of a Notary Public to complete the I-9 work eligibility form.• Complete all other forms and submit by tracked mail to: Nannette Lindsay, 3663Woodward Avenue, Cubicle 4-1304, Detroit, MI 48201, to arrive on or before May 10.3

MIDTOWNREPORTING FOR YOUR PRE-PLACEMENT PHYSICALAT OCCUPATIONAL HEALTH SERVICES, UNIVERSITY HEALTH CENTER(Part of the DMC Detroit Receiving Hospital complex)4201 ST. ANTOINE, 4 TH FLOOR, 4K, DETROIT, MI 48201, (313) 745-4522(Present this sheet at time of appointment.)Note: Please arrive 15 minutes prior to appointment and do not bring persons (including children)with you to your appointment, as we cannot accommodate them.PARKINGIf you choose to valet park (bear to the right upon entry into the drive), your parking cost will becovered – validated by Occupational Health Services when you arrive at the department. If youchoose to self-park (bear to the left for underground self-parking), the cost for underground selfparkingis $2.50 and will not be covered.WHAT TO BRING TO YOUR PRE-PLACEMENT PHYSICAL• Picture ID (drivers license, state ID or U.S. passport are acceptable forms of identification)• Any medications that you are currently taking• If available, documentation of all TB testing conducted within the past 12- months• If available, vaccination documentation for MMR, Vz, Hep B, Tdap and seasonal flu• If available, lab report documenting immunity to Hepatitis B, Measles, Mumps, Rubella andVaricella Zoster (chicken pox)• Your glasses or contact lenses (if applicable)In most cases the physical requires one visit to the clinic but on occasion two visits arerequired. We will provide the one visit option whenever possible – however we cannot guarantee it.The pre-placement physical consists of the following:• Tuberculosis screening – This screening may include two TB skin tests be placed and read ora blood test or other evaluation as indicated by the clinic.• Urine and/or blood sample for Drug and Alcohol screen• Vision screening• N95 Respirator Fit Testing (required ONLY of employees who will have patient contact)If you need to be fit tested for respirator use, you will need to be clean shaven in the mask-tofaceseal zone. This means no facial hair except a well-trimmed moustache. If this applies toyou, please shave prior to your appointment. Otherwise, you will need to shave while on-site tocomplete the respirator fit test process.• For the safety of our patients, all new DMC employees are required to have immunity tothe following vaccine preventable diseases: Measles, Mumps, Rubella and VaricellaZoster. Seasonal flu vaccine is required during flu season. Vaccination against Pertussis(Tdap) is required for all employees working in facilities that provide patient care. DMCOccupational Health Services will confirm your current immune status and willadminister the appropriate vaccine(s) at no cost to you. Additionally, those who lackimmunity to Hepatitis B will be encouraged to accept the Hepatitis B vaccine at no costto them.4

SINAI-GRACE HOSPITALREPORTING FOR YOUR PRE-PLACEMENT PHYSICALAT SINAI-GRACE HOSPITAL (Professional Office Building)6001 West Outer Drive, Suite 203, DETROIT, MI 48235, (313) 966-4807(Present this sheet at time of appointment.)Note: Please arrive 15 minutes prior to appointment and do not bring persons (including children)with you to your appointment, as we cannot accommodate them.PARKINGUpon pulling into the drive, you can bear to the right for valet parking (not reimbursed), or to the leftfor self-parking. The cost for self-parking is $3.00. If you self-park, you can request a slip forreimbursement at Occupational Health.WHAT TO BRING TO YOUR PRE-PLACEMENT PHYSICAL• Picture ID (drivers license, state ID or U.S. passport are acceptable forms of identification)• Any medications that you are currently taking• If available, documentation of all TB testing conducted within the past 12- months• If available, vaccination documentation for MMR, Vz, Hep B, Tdap and seasonal flu• If available, lab report documenting immunity to Hepatitis B, Measles, Mumps, Rubella andVaricella Zoster (chicken pox)• Your glasses or contact lenses (if applicable)In most cases the physical will require two visits to occupational health.The pre-placement physical consists of the following:• Tuberculosis screening – This screening may include two TB skin tests be placed and read ora blood test or other evaluation as indicated by the clinic.• Urine and/or blood sample for Drug screen• Vision screening• N95 Respirator Fit Testing (required ONLY of employees who will have patient contact)If you need to be fit tested for respirator use, you will need to be clean shaven in the mask-tofaceseal zone. This means no facial hair except a well-trimmed moustache. If this applies toyou, please shave prior to your appointment. Otherwise, you will need to shave while on-site tocomplete the respirator fit test process.• For the safety of our patients, all new DMC employees are required to have immunity tothe following vaccine preventable diseases: Measles, Mumps, Rubella and VaricellaZoster. Seasonal flu vaccine is required during flu season. Vaccination against Pertussis(Tdap) is required for all employees working in facilities that provide patient care. DMCOccupational Health Services will confirm your current immune status and willadminister the appropriate vaccine(s) at no cost to you. Additionally, those who lackimmunity to Hepatitis B will be encouraged to accept the Hepatitis B vaccine at no costto them.5

HURON VALLEY-SINAI HOSPITALREPORTING FOR YOUR PRE-PLACEMENT PHYSICALAT HURON VALLEY-SINAI HOSPITAL1 William Carls Drive, Commerce, MI 48382, (248) 937-3405(Located on ground floor – North Orchard entrance)Hours of operation: Mon–Fri, 7:00 am–3:30 pm)Note: Please arrive 15 minutes prior to appointment and do not bring persons (including children) with you to yourappointment, as we cannot accommodate them.WHAT TO BRING TO YOUR PRE-PLACEMENT PHYSICAL• Picture ID (drivers license, state ID or U.S. passport are acceptable forms of identification)• Any medications that you are currently taking• If available, documentation of all TB testing conducted within the past 12- months• If available, vaccination documentation for MMR, Vz, Hep B, Tdap and seasonal flu• If available, lab report documenting immunity to Hepatitis B, Measles, Mumps, Rubella and Varicella Zoster(chicken pox)• Your glasses or contact lenses (if applicable)In most cases the physical will require two visits to occupational health.The pre-placement physical consists of the following:• Tuberculosis screening – This screening may include two TB skin tests be placed and read or a blood test orother evaluation as indicated by the clinic.• Urine and/or blood sample for Drug screen• Vision screening• N95 Respirator Fit Testing (required ONLY of employees who will have patient contact) If you need to befit tested for respirator use, you will need to be clean shaven in the mask-to-face seal zone. This means no facialhair except a well-trimmed moustache. If this applies to you, please shave prior to your appointment. Otherwise,you will need to shave while on-site to complete the respirator fit test process.• For the safety of our patients, all new DMC employees are required to have immunity to the followingvaccine preventable diseases: Measles, Mumps, Rubella and Varicella Zoster. Seasonal flu vaccine isrequired during flu season. Vaccination against Pertussis (Tdap) is required for all employees working infacilities that provide patient care. DMC Occupational Health Services will confirm your current immunestatus and will administer the appropriate vaccine(s) at no cost to you. Additionally, those who lackimmunity to Hepatitis B will be encouraged to accept the Hepatitis B vaccine at no cost to them.6

HUMAN RESOURCES NEW EMPLOYEE PAPERWORKON-SITE MEETINGS(See Manager for Schedule)SINAI-GRACE HOSPITAL MIDTOWN HURON VALLEY-SINAI6071 West Outer Drive 1 William Carls Drive,1 st Floor Lourdes Commerce, MI 48382Detroit, MI 48235(Ground floor–North Orchard entrance)(313) 966-3101WHAT TO COMPLETE BEFORE COMING TO THE HUMAN RESOURCES MEETING AT YOUR SITE:Please review and complete as many of the documents as possible. This will shorten the time required for themeeting.• Employment Application • Payroll Direct Deposit / Global Cash Card• Acknowledgement and Acceptance ofEmployment• Acknowledgement of Receipt of SexualHarassment Brochure• Confidentiality of Information Statement • Compliance Program Certification Form• Customer Service Standards • Detroit W-4 Tax Form• Equal Employment Data • MI-W4 Michigan Tax Form• Pre-employment Certification • Federal W-4 Tax Form• Voluntary Equal Employment Data • I-9 Employee Eligibility Verification Form (SectionA only)• Work Opportunity Tax Credit Program • Complete Employee Online Education Modules(NetLearning)WHAT TO BRING TO THE HUMAN RESOURCES SITE MEETING (new employee paperwork):• Originals of all documents necessary to establish your identity and employment eligibility (per Department ofHomeland Security Form I-9 guidelines). This may include, but is not limited to: picture ID (such as driverslicense, state ID or U.S. passport), social security card, birth certificate, visa.• Original valid social security card – regardless of which document you choose to show for the I-9document. This is for payroll purposes. (Note: Your paycheck will be issued to the name that appears onyour social security card.)• IMPORTANT: THE LEGAL NAME ON YOUR PICTURE ID AND SOCIAL SECURITY CARD MUST BETHE SAME.• Original education credentials (high school diploma, GED documentation and college degree as applicable)and evidence of applicable licensure/certifications/registrations. Graduate Nurses please bring your degreeor a letter of completion from your school.7

Final PagePLEASE PRINT. USE BLACK INK ONLY. READ CAREFULLY. COMPLETE ALL SECTIONS.Last Name First Middle Social Security #We are an equal opportunity employer and will not unlawfully discriminate on the basis of race, color, sex, religion, national origin, age, height,weight, marital or veteran status, or the presence of a medical condition or disability.Michigan and Federal law require employers to make accommodations to persons with a disability if the disability can be accommodated withincertain guidelines, and the individual can perform the essential job duties with or without such accommodation.Persons with a disability may request an accommodation of their disability by notifying the organization in writing of the need for anaccommodation. Failure to properly notify the employer in writing of the need for an accommodation within 182 days from the date the personwith a disability knows or should know that an accommodation is needed will preclude any State claim that the employer failed to accommodatethe person with a disability. This 182 day requirement does not apply to a claim filed under the Americans with Disabilities Act.It is a violation of the DMC Nepotism Policy for an employee to work permanently under the supervision(indirect or direct) of a relative. In your new position, will anyone in department supervision/managementto which you were hired be your relative? Yes NoIf yes, Relative Name:Relationship:Person to be notified in case of an accident or emergency:Name:RelationshipAddress: Phone #: ( )Are you in the military reserves? Yes No If yes, date obligation ends:Foreign Language: Read Write Speak SignI certify that all of the information I have given in this document is accurate and complete and is subject to verification by the Detroit MedicalCenter. I hereby authorize investigation of all statements contained in this application, the submitted resume, and full disclosure of my presentand prior work record. I grant permission to the organization to obtain information concerning my general reputation, character, conduct andwork quality. I authorize any person or organization contacted to furnish information and opinions concerning my qualifications for employment,whether same is a matter of record or not, including personal evaluation of my honesty, reliability, carefulness and ability to take orders from mysuperiors. I understand that this may include a record of disciplinary action assessed by previous employers. I hereby release the organizationand any person or other organization from any and all liability which may result from furnishing such information or opinion, exclusive of statutoryclaims, where applicable. I hereby release the organization and any person, organization or prior employer from any obligation to provide mewith written notification of such disclosure.I understand that employment is contingent upon this investigation and, if employed, misrepresentation or falsification of material facts in thisapplication and the submitted resume, or the omission of any information shall be considered sufficient grounds for dismissal. I understand andagree that if, in the opinion of the organization, the results of the investigation are unsatisfactory, that an offer of employment that has beenmade may be withdrawn or my employment with the organization may be terminated. I further understand that this offer is contingent uponsuccessful completion of 1) a pre-placement physical examination, including a drug screen and TB test; 2) reference verification; 3) abackground check; 4) pre-employment eligibility verification. (Completion of the I-9 Form requires that you provide documentation whichsupports your legal right work in the U.S.); and 4) completion of Net Learning Training, all prior to the start date. I further understand that myoffer is also contingent on the DMC having a continuing need for personnel in the position offered as of my start date.I note this application and the submitted resume is not an offer for a contract of employment I understand and agree that if I am employed bythe organization my employment shall be subject to the following conditions: 1) I may be terminated at any time with or without notice and withor without cause, 2) I will receive wages and benefits pursuant to the organization’s rules and regulations and the organization may change suchrules and regulations at any time, without notice to me, 3) My assigned work hours may be modified by the organization, and if requested, I willbe required to work overtime, 4) Upon accepting any offer of employment made by the organization, I will execute an Acknowledgment andAcceptance of Employment as requested by the organization. Further, in cases where job specifications require certain credentials, educationand/or experience, I understand that I must be able to submit documentation to the DMC to support these requirements.I have read, understand and agree to the above statements and conditions of employment.Signature:Date:1/23/12 HR Employment application page 6-Rev 1-12 non-employee.doc13

IMPORTANT -- Requires Your Immediate Attention and SignatureJanuary 1, 2010Dear New DMC Employee:The Detroit Medical Center/ Vanguard Health Systems is participating in the Work Opportunity Tax Creditprogram (WOTC) and Ernst & Young is administering this program for us. This federal program involves yourreview, completion, and submission of the documents included in this mailing. All information requested andprovided will be kept confidential by Ernst & Young staff. The information will not be shared with DMC staff norwill it affect your job, wages, or taxes in any way.This is a voluntary process but we hope that you will participate. Your participation will insure that DMC receivesall the tax credits possible as we continue to partner with the City of Detroit to improve our facilities and the qualitycare given to our communities. Attached to this letter, you will find three documents to complete and return usingthe postage-paid envelope addressed to Ernst & Young:3 Easy Steps- The WOTC Questionnaire- Form 8850- Form W-41. Please complete all questions on the WOTC Questionnaire, including your work site location.2. Please be sure to complete fully Forms 8850 and W-4.3. Please double-check that you have completely filled in both forms, signed and dated where appropriate, andplaced them in the postage paid envelope.Mail all completed forms to Ernst & Young in the enclosed postage paid envelope immediately. The formmust be mailed within 20 days of your hire.If you have additional questions, please contact Ernst & Young customer service representatives at 1-866-267-5866.Ernst & Young WOTCAttn: WOTC Processing CenterP.O. Box 226896Dallas, TX 75222Phone # 1-866-267-5866Thank you for your attention to this process.Sincerely,Michael E. DugganPresident /CEODetroit Medical CenterHR/WOTC/1-1-11Kent WallaceChief Operations OfficerVanguard Health Systems14

POST-OFFER INFORMATIONCongratulations on accepting a position with the Detroit Medical Center. Per Detroit Medical Center policy, your joboffer is contingent upon successful completion of the following, prior to your start date:1) pre-placement physical examination, including a drug screen and TB skin test2) reference verification3) criminal background check4) pre-employment eligibility verification. (Completion of the I-9 Form requires that you providedocumentation which supports your legal right work in the U.S.)5) completion of Net Learning TrainingYour hire is also contingent on the DMC having a continuing need for personnel in the position offered as of yourstart date.Date of Birth ________________________________17

Equal Employment DataThe DMC enters into contracts with the federal government; therefore, it is required to maintain data regarding thegender, ethnicity, disability and veteran status of its applicants and employees. If provided, the data will be storedseparately and used for statistical analysis and affirmative action purposes only. The DMC is an equal employmentopportunity employer and considers all applicants and employees without regard to race, color, religion, gender,sexual orientation, national origin, age, marital status, medical condition, disability or other legally protected status.New Hire DataName: ______________________________Please printFederal Equal Employment DataPlease check one in each applicable category. Refer to definitions below.Race____ American Indian or Alaska Native (Not Hispanic or Latino)____ Asian (Not Hispanic or Latino)____ Black or African American (Not Hispanic or Latino)____ Hispanic or Latino____ Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)____ White (Not Hispanic or Latino)____ Two (2) or more races (Not Hispanic or Latino)Signature: ___________________________________Zip Code: ____________________________Equal Employment Race DefinitionsGender____Male (M)____Female (F)Date: ______________American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the originalpeoples of North and South America (including Central America), and who maintains tribal affiliation or communityattachment.Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, SoutheastAsia, or the Indian subcontinent including, for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,the Philippine Islands, Thailand and Vietnam.Black or African American (Not Hispanic or Latino) – A person having origins in any of the Black racial groups ofAfrica.Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanishculture or origin.Native Hawaiian or other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the originalpeoples of Hawaii, Guam, Samoa or other Pacific Islands.White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle Eastor North Africa.Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above races.HR/EEO 4/9/200918

Voluntary Equal Employment DataThe DMC enters into contracts with the federal government; therefore, it is required to maintain data regarding thedisability and veteran status of its applicants and employees. If provided, the data will be stored separately andused for statistical analysis and affirmative action purposes only. Your decision to provide or not provide thisinformation will have no impact on your prospects for employment with the DMC.The DMC is an equal employment opportunity employer and considers all applicants and employees without regardto race, color, religion, gender, sexual orientation, national origin, age, marital status, medical condition, disability orother legally protected status. Please voluntarily provide the following information.New Hire DataName: ______________________________Please printZip Code: ____________________________Federal Equal Employment DataPlease check one in each applicable category. Refer to definitions located below and on the reverse side of thisform.Are You An Individual With A Disability? (See definition below)____ Yes (Y)____ No (N)Veteran Status (If applicable select all that apply)____ Not a Veteran ____ Disabled Veteran ____ Other Protected Veteran____ Recently Separated Veteran (3 Years)____Armed Forces Service Medal VeteranSignature: ___________________________________Date: ______________DisabledIndividual with a Disability – Is a person who has a physical or mental impairment which substantially limits oneor more major life activities; has a record of having such impairment; or who is regarded as having such animpairment.HR/EEO 4/09/2009Completed by Employment19

Veteran Status DefinitionsDisabled Veteran – 1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation(or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by theSecretary of Veterans Affairs or 2) A person who was discharged or released from active duty because of aservice-connected disability.Other Protected Veteran – Refers to a veteran who served on active duty in the U.S. military, ground, naval or airservice during a war or in a campaign or expedition for which a campaign badge has been authorized, under lawsadministered by the Department of Defense. For a complete list of the covered wars, campaigns or expeditions that meetthis criterion, log on to the government’s website at http://www.opm.gov/veterans/html/vgmedal2.asp.Recently Separated Veteran – Any veteran during the three-year period beginning on the date of such veteran’sdischarge or release from active duty in the U.S. military, ground, naval or air service.Armed Forces Service Medal Veteran – Any veteran who, while serving on active duty in the U.S. military,ground, naval or air service, participated in a United States military operation for which an Armed Forces servicemedal was awarded pursuant to Executive Order 12985.HR/EEO 4/09/2009Completed by Employment20

Confidentiality of Information StatementThis document must be signed by all employees of the Detroit Medical Center as a condition of employment, and byany other non-DMC employee prior to being assigned duties or a computer access code or password authorization. Noalterations to this statement are allowed.I am an employee, medical resident, physician, student/intern, or individual assigned to the DMC or an affiliatethereof, including, for example, a member of the medical staff at the DMC, or an individual associated with acontractor of the DMC. I understand that information is required for me to perform my duties for or on behalf of theDMC, or with respect to DMC patients. Some of this information may concern patients being treated at the DMC or itmay concern the operations of the DMC. I understand that patient medical and personal information belongs to thepatient and that I am only permitted to access or disclose patient medical and personal information to the extent that itis necessary to provide patient care or perform my duties in accordance with DMC policy. I also understand that allmedical and personal information regarding patients is confidential and, unless directly related to the care of patients,payment for patient services or health care operations, should not be revealed or discussed with other patients, friendsor relatives, or anyone else within or outside the DMC.I also understand that other information regarding the operations of the DMC is confidential. This includes anyinformation regarding employees, financial operations, quality assurance, utilization review, risk management,research procurement, contracting and credentialing of staff. I understand that I am only authorized to access thisinformation if it is required for me to perform my duties. This information should not be revealed or discussed withothers within or outside the DMC except in accordance with DMC policy and to the extent that this discussion isnecessary to perform my duties.I understand that I am required to protect any DMC patient or operations information from loss, misuse, unauthorizedaccess, or unauthorized modification, and to report any suspected breach of privacy and security policies to theVanguard Compliance Hotline (1-888-895-9945).I understand that I may be given access codes or passwords to DMC computer systems. I will safeguard the securitycodes and passwords given to me. I acknowledge that I am strictly prohibited from disclosing my security codes toanyone including my family, friends, fellow workers, supervisors, and subordinates for any reason.I understand that I may use my access security codes to perform my duties only. I agree that I will not use anyoneelse’s security codes to obtain access to any computer systems. I understand that I will be held accountable for allwork performed or changes made to the system or database under my security codes and that I am not to allow anyoneelse to access the computer using my security codes, or leave my computer unattended and permit anyone else toaccess the system through my computer password.I understand that failure to follow the confidentiality of information statement is cause for termination of employment,revocation of privileges, or revocation of access to the DMC and/or its information systems, and may be noted in mystudent or personal record, and may result in notice to my educational institution or my agency or employer, if such arelationship exists._______________________________________Signature___________________DateDMC ComplianceConfidentiality of Information StatementRevised 12/27/1121

Acknowledgment and Acceptance of EmploymentI accept your offer of employment and I understand that my employment shall be subject to theadditional provisions outlined below:1. My employment shall be governed by the rules, regulations, policies and procedures ofthe organization, which may be revised from time to time at the sole discretion of theorganization.2. I agree that I shall not commence any action or other legal proceeding relating to myemployment or the termination thereof more than six months after the vent complained ofand I voluntarily waive any statute of limitations to the contrary.3. I understand that I have an ongoing obligation to report any felony or misdemeanorconvictions (excluding misdemeanor traffic convictions where operating a vehicle is not apart of your job function) while employed at the DMC, or any pending felony convictions,and failure to do so may result in my termination. I understand that the conviction itselfmay not disqualify me from employment with the DMC.4. I understand the Detroit Medical Center is committed to providing a smoke free environmentand prohibits smoking of any kind in all of its facilities, grounds, vehicles and all property, whetherowned or leased. This includes the use of e-cigarettes. I understand violation of this policy mayresult in discipline, up to and including discharge.5. I understand that as a condition of my employment in any DMC facility providing patient care, I willobtain the seasonal influenza vaccine and any additional influenza vaccination determined to berequired when it is available on an annual basis. I understand that failure to obtain this vaccine,without a bona fide contraindication, may result in discipline, up to and including discharge. Iunderstand that I will be vaccinated at the time of hire against pertussis (Tdap Vaccine), or providedocumentation of prior Tdap vaccination, or provide acceptable documentation of acontraindication. I understand that failure to do so may result in discipline, up to and includingdischarge.6. My employment may be terminated at any time, with or without notice and with or withoutcause.7. This constitutes the entire agreement between the organization and myself and all prioragreements are null and void. Further, nothing published by the organization, eitherbefore or after this agreement, shall in any way modify anything contained herein; and8. This agreement cannot be modified by any oral or written representations made byanyone employed by the organization, either before or after this agreement, except by awritten document directed exclusively to me and signed by the Chief Executive officer ofthe organization, or his/her designee.Signature:______________________________ Date: ___________________ACKACCEMIII 1/25/12.xls/Employment22

INFORMATION ONPREVENTINGSEXUALHARASSMENTFor DMC Employees, Agents,Students, Medical and HouseStaff,Visitors, Patients, Vendors,Volunteersand Persons affiliated with theDMCA message regarding DMC'sPolicyProhibiting SexualHarassment...DMC's CommitmentThe DMC is committed tocreating an environment inwhich all persons are treatedrespectfully and fairly. It is thepolicy (HR #511 and CG 018) ofthe Detroit Medical Center("DMC") to maintain a workenvironment free of sexualharassment, includingharassment based upon hostilework environment. The DMCwill not tolerate sexualharassment of its employees bysupervisors, co-workers orothers; nor will harassment ofnon-employees by any DMCemployee be condoned. Thisreinforces the DMC's zerotolerance of sexual harassmentas a violation of the Code ofConduct.StandardsWe are all expected to conductourselves so as to maintain anenvironment that is free ofharassment. Sexual harassmentis a serious form of misconductfor which discipline up to andincluding discharge may occur.Harassing behavior will not betolerated by any individual.No RetaliationNo retaliation or reprisals will betolerated against any individualwho in good faith raises aconcern or makes a chargeabout behavior that may violatethis policy. Nor will there betolerance of any form ofretaliation against an individualwho participates in theinvestigation of any incident ofalleged sexual harassment.What to doAny person who believes he/sheis being subjected to sexualharassment should immediatelynotify his/her direct supervisor,the Human Resourcesdepartment or the DMCCompliance Hotline. Allcomplaints of sexualharassment will be investigatedconfidentially and appropriateaction will be taken.Michael E. DugganPresident and Chief ExecutiveOfficerDetroit Medical CenterWhat Are Examples of SexualHarassment?Examples include unwelcomebehavior, such as:• Unwanted, unsolicited oroffensive sexual advances andrequests for sexual favors.• Touching and physical contact ofa sexually inappropriate nature.• Display or use of posters,calendars and pictures of asexually inappropriate nature inany work area.• Making comments or jokes of asexual nature.• Gestures, whistling or othersimilar behavior of a sexuallyinappropriate nature.• Use of e-mail or Internet to sendmessages or materials of asexually inappropriate nature.23

If You Think You Have BeenSubjected to SexualHarassment...• Don't Delay. Immediately reportyour concerns. Contact yourmanager or his/her boss. Thereare other contact personsavailable:• The Human ResourcesDepartment for your operatingunit.• The DMC Compliance Hotline tollfree at 1-800-8ETHICS.A Reminder to DMC Employeeson Consequences forContributing to or Creating aSexually HarassingEnvironmentThe DMC prohibits any of itsemployees from engaging in anyform of sexually harassing behaviordirected to other employees,patients, visitors, physicians or otherpersons affiliated with the DMC. Allallegations of sexual harassment willbe investigated. Sexual harassmentby an employee is a serious form ofmisconduct for which an employeemay be disciplined, up to andincluding discharge, in accordancewith the progressivediscipline/corrective action policy.Questions and AnswersQ: Does sexual harassment onlyhappen to women?A: No, men can also be therecipients of sexual harassment.Q: Is sending e-mails of a sexualsuggestive nature in violation ofthe DMC Sexual HarassmentPolicy?A: Yes, sending sexually suggestivee-mail is inappropriate in theworkplace.Q: Can a person be sexuallyharassed even if he/she is notthe target of the harassingbehavior?A: Yes, even though not the target,a person could be subjected toseeing, hearing or experiencingthings or behaviors that maycause them to feeluncomfortable or threatened.Q: If I am a manager, what should Ido if I receive a sexualharassment complaint from oneof my employees?A: Contact your Human ResourcesDepartment and they will workwith you directly. Do not make adetermination on the complaintuntil you talk with HumanResources. They will assist inconducting a thorough andconfidential investigation.Q: If I am an employee and I file acomplaint, will the complaint behandled confidentially?A: Confidentiality in the reportingand investigation of complaints isimportant to the DMC. We shallstrive to complete eachinvestigation in a private andconfidential matter.Confidentiality will be maintainedexcept when it cannot beprotected due to a subpoena oroutside intervention or when theinvestigation requires notice toother individuals.Q: Could I be subject to retaliation ifI report an incident of sexualharassment?A: No. As stated in the DMC SexualHarassment Policy, no retaliationwill be tolerated against anyindividual who in good faithraises a concern or makes acomplaint about behavior thatmay violate this policy.Q: Why can't I have sexuallysuggestive posters, calendars orpictures in my work area?A: First, the items areunprofessional and inappropriatein a work environment. Second,the items can be seen byanother employee, patient/familymember or others who areuncomfortable with them.IMPORTANT TELEPHONENUMBERSHuman Resources DepartmentChildren's, Detroit Receiving, HarperUniversity, and Hutzel Women'sHospitals, Rehabilitation Institute,DMC Parent, DMC UniversityLaboratories..........................(313) 578-3547Huron Valley-Sinai Hospital..........................(248) 937-4041DMC Surgery Hospital..........................(248) 733-2331Sinai-Grace Hospital..........................(313) 966-3101Other DMC Sites: Call one of thenumbers listedabove.DMC Employee AssistanceProgram(313) 745-1900(877) 789-3271 Toll Free1-800-8ETHICS Toll FreeS p o n s o r e d b y :DMC Human ResourcesDepartment(11/08)326430ZR (11/08)24

Acknowledgement of Receipt of the DMCSexual Harassment BrochureI have received a copy of the DMC Brochure titled “Information on Preventing Sexual Harassment.” I agree to readthe document and to conduct myself appropriately in the workplace.____________________________Signature____________________________Print Name___________________________Date___________________________Employee NumberDMC ComplianceAcknowledgement BrochureRevised 12/27/1125

Pre-Employment Certification RegardingFederal Program Participation1. I understand that the term “Program” means any program funded wholly or partly by the federal or stategovernment, including Medicare, Medicaid, CHAMPUS and the Public Health Service.2. I certify that I am not and never have been excluded from or denied participation in a Program.3. I certify that I am not and never have been an owner or investor in any entity that has been excluded from ordenied participation in a Program.4. I certify that, to the best of my knowledge and belief, I am not under investigation for any charge that would resultin my exclusion from participation in a Program.5. I certify that, to the best of my knowledge and belief, I am not an owner or investor in any entity that is underinvestigation for a charge that would result in its or my exclusion from participation in a Program.6. I understand that if I am excluded from participation in a Program that my employer may not bill that Program forany services that I render and may not include the costs of my salary, wages or benefits on its cost reports.Therefore, I agree, as a condition of my employment, that I am financially responsible for any losses incurred bymy employer as a result of my employer’s inability to bill for services I perform if I am excluded from Programparticipation.7. I understand and agree, as a condition of my employment, that I am required to report to the VanguardCompliance Hotline (1-888-895-9945) any information I have that might indicate that I am under investigation fora charge that would result in my exclusion from participation in a Program.8. I understand and agree, as a condition of my employment, that I am required to report to the VanguardCompliance Hotline (1-888-895-9945) if I become excluded from participation in a Program.9. I understand and agree that my failure to inform my employer of information regarding actual or potentialProgram exclusion may result in immediate termination of my employment for cause.____________________________Signature____________________________Print Name___________________________Date___________________________Employee NumberDMC CompliancePre-Employment CertificationRevised 12/27/1126

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DMC PAYROLL SYSTEMIn an effort to be more environmentally friendly, and to reduce the costs of printing and postage, the DMChas a paperless payroll environment. DMC pays all employees electronically. You have a choice of oneof two ways to be paid:1. Sign up for direct depositSee the attached instructions.2. Enroll in the Global Cash Card ProgramFor those employees who do not want to open a checking or a savings account in order to usedirect deposit, a Global Cash Card (Paycard) will be available. This card does not provideaccess to a savings or checking account. The card is issued to the employee, and the net pay isdeposited onto the card each pay period.Employees may request a change in the method of receiving wages at any time. Changes must besubmitted directly to the Payroll Department, and will take effect with the first full pay period followingreceipt of properly completed and authorized forms.DMC Payroll Department:(313) 578-3703Children's Hospital of MichiganDetroit Receiving HospitalSinai-Grace HospitalPhysicians of Michigan(313) 578-3704Harper University HospitalHutzel Women's HospitalDMC Surgery HospitalHuron Valley-Sinai HospitalDMC CorporateDMC University Labs(313) 578-3706Rehabilitation Institute of MichiganDMC Education & Research (Includes GME)Managed Care(313) 578-2057Total Linen ServicesEmployment 12/21/1131

Direct Deposit MeansMore Convenience for You!The Detroit Medical Center is pleased to offerthe convenience of electronic Direct Deposit of yourpayroll checks.With Direct Deposit, you may have your payrollchecks automatically deposited into an account at thefinancial institution of your choice. In fact, you mayhave your payroll checks split up and deposited intoas many as three different accounts in the UnitedStates.You must have the entire amount of your payrollchecks directly deposited. You cannot have part ofeach payroll check directly deposited and receive theremainder as a paper check. Direct Deposit gives you three basic advantages overgoing to the bank and manually depositing yourpayroll checks:1. You will generally have faster access to yourmoney. In most cases, your funds will bedeposited into your account(s) by mid-morningof each payday.2. You will save time. You will no longer have towait in line at the bank to cash or deposit yourpayroll check.3. Your money will be safer. Dollars areelectronically transferred into your account(s)each and every payday.To Enroll in the Direct Deposit Program:1. Get the number of each account(s) in to whichyou want your payroll checks directly deposited.If you do not have an account and wish to openone, go to the financial institution of your choice.2. Complete the Electronic Direct Deposit of PayAuthorization Form (the next 2 pages of thisdocument). Be sure to sign the form, and toattach a voided personal check or otherverification from your financial institution foreach of your checking or savings account(s) intowhich you want funds Directly Deposited.3. Bring your completed Electronic Direct Depositof Pay Authorization Form to the PayrollDepartment. You can also scan an electroniccopy to your facility’s designated Payroll e-mailbox.Note: Please double check the information that youprovide on this form. Errors or missing informationmay cause delays in the direct deposit of funds intoyour account(s).Important Reminders About the DirectDeposit Program:1. Before you can have Direct Deposit, the DetroitMedical Center requires that you complete andsign a statement authorizing your employer toelectronically deposit your funds, and to adjustentries in order to correct errors as necessary.Please remember that you can have direct deposit ofyour payroll checks at the financial institution(s) ofyour choice.Also, remember that the entire amount of yourpayroll check must be directly deposited. You cannothave part of each payroll check directly deposited,and receive the remainder as a paper check.2. All information submitted on an ElectronicDirect Deposit of Pay Authorization Formsupersedes all previously submitted information.Therefore, when submitting a new form, be sureyou list ALL ACCOUNTS into which you wantfunds to be directly deposited.I:\PAYROLL\Dept. Forms\Direct Deposit (09-11).doc32

Employee Name:Electronic Direct Deposit of Pay Authorization Form (Page 1 of 2)(Please complete both pages of this form. Keep a copy of this form for your own records)SSN:(Last Four Digits)Employee #: Phone #:(Daytime)Process Level #: Pager #:(Choose from list below)Process LevelsChildren’s Hospital of Michigan 605 Huron Valley Sinai Hospital 625Detroit Receiving Hospital 610 Hutzel Women’s Hospital 630DMC Corporate 650 Managed Care 656University Labs 651 Rehabilitation Institute of MI 635DMC Physicians of Michigan 653 Sinai Grace Hospital 675DMC Surgery Hospital 632 Total Linen Services 655Harper University Hospital 620 CRNAs of Michigan 654Print the routing number and the account numberassociated with each account into which you arerequesting funds to be deposited, as well as the perpay-period amount, and the type of account (i.e.,checking or savings) NOTE: All of your net paymust be directly deposited. You cannot use directdeposit for part of your pay and receive a paper checkfor the rest.If you are depositing your entire paycheck into oneaccount, write “NET PAY” in the Amount ($) PerPaycheck: column. If you are depositing yourpaycheck into two or three accounts, indicate the dollaramounts (percentages are not allowed) for the first (andsecond) accounts, and write “Remainder of net pay” forthe final account. (As shown below)SampleTo Deposit in 1 account: To deposit in 2 accounts: To deposit in 3 accounts:1. Net pay (checking/savings) 1. Amount ($) to deposit 1. Amount ($) to deposit2. Remainder of net pay 2. Amount ($) to deposit3. Remainder of net payFinancialInstitution(s) Routing Number:Account Number(s):Amount ($)Per Paycheck: Checking Savings1.2.3.[ ] [ ][ ] [ ][ ] [ ]Note: Please double check with your financial institution(s) regarding the correct routing number andaccount number(s) that you are providing on this form. Errors or missing information will cause delaysin the direct deposit of funds into your account(s). For all checking accounts, a voided check mustaccompany this form.33

Electronic Direct Deposit of Pay Authorization Form (Page 2 of 2)(Please complete both pages of this form. Keep a copy of this form for your own records)Today’s Date:I authorize my DMC subsidiary and the financialinstitution(s) listed below to deposit fundsautomatically (via electronic transmission) to mychecking and/or savings account(s) each payday. Ialso authorize them to adjust entries in order to correcterrors, as necessary. This authority will remain ineffect until I have canceled it in writing.Your Name (please print):Your Signature:_______________________________________________________________________________________(Name of Financial Institution)_______________________________________________________________________________________(Name of Financial Institution)_______________________________________________________________________________________(City and Stage)_______________________________________________________________________________________(Name of Financial Institution)_______________________________________________________________________________________(City and Stage)Note: The information on this form will replace any previous Electronic Direct Deposit of PayAuthorization Form that you have submitted. Please be sure you have listed all accounts (no more thanthree) into which you would like funds deposited.I:\PAYROLL\Dept. Forms\Direct Deposit (09-11).doc34