AFFILIATE ORIENTATION MANUAL By signing this document, I have read the Orientation Agreement and Acknowledgement for Non-Cone Health employed individuals providing care, treatment and services and agree to abide by Cone Health policies while associated with Cone Health and to seek assistance with and/or clarification of these policies if needed. I have received the information on the iCARE Commitments, confidentiality (HIPAA), compliance and integrity, safety/ quality concerns, Hand Hygiene and Standards of Appearance and Dress Code policies, emergency responses, and the National Patient Safety Goals related to the standards expected of all Non-Cone Health employed individuals providing care, treatment and services, and commit to abide by them. By my signature, I confirm that this Acknowledgement has been reviewed by me. _____________________________________________________________________________________________ Name (Printed) Signature _____________________________________________________________________________________________ Date Name of Affiliate/Agency _____________________________________________________________________________________________ Cone Health Responsible Leader’s Name (Printed) Complete this form and email it to: ________________________________________________________________ ORIENTATION AGREEMENT and ACKNOWLEDGEMENT for NON-CONE HEALTH EMPLOYED INDIVIDUALS Providing Care, Treatment, and Services 30