* PA signature attest that, the timesheet accurately reflects of my Workplace / Address, on the specific days and hours PA and has provided the necessary task agreed by the consumer according to MLTC and Signed DAILY. (TICK MARK only that PA has performed that job).

* PA understands that failure to accurately complete this timesheet may consider as FRAUDULENT and may resulting disciplinary action. (STRICTLY: CONSUMER CANNOT CHANGE PA FOR PERSONAL GAIN OR GOVERNMENT BENEFITS). SARAH CARE HAS RIGHT TO TAKE BACK ANY PAYMENT PAID TO PA FROM THEIR PAYCHECK FOR NON AUTHORIZED WORKING HOURS/DAYS ACCORDING TO NYS DOH/MEDICAID REGS.

* PA is hired by consumer (Parents) to provide services to them. PA is not eligible to claim any state/federal benefits illegally. PA is not directly hired by the Sarah Care agency to provide services to the consumer. *** All pay includes all benefits.

NOTE: PA will NOT get paid that day when Consumer is an Admitted in Hospital, Nursing/Rehab Facility OR on Vacation. In case of emergency, please call 911 then notify your MLTC and Sarah Care USA (917-745-0949) IMMIDIATELY.