Welcome About Services Practices Announcements Employee Documents Employee Documents General employment documents and forms: Employee Handbook 2019 Request for Time Off (to be returned to your immediate supervisor upon completion) Release of Protected Health Information (PHI) for Other Purposes and Activities Printable Chronic Care Management (CCM) forms: CCM Correctional Demo Insurance Sheet CCM Manual 2017 CCM Opt-Out Form CCM Opt-Out & Opt-In Log Patient Forms for Clinic 2017 CCM Phone Encounter CCM Time Log 2017 Patient Consent for Chronic Care Services January 2016 The following forms will need to be printed, filled out, and returned to Suzanne Bolton: Compliance/HIPAA Acknowledgement Form Notice of Privacy Practices Acknowledgement Form The following forms will need to be printed, filled out, and returned to Susan Hall, Human Resources: 2017 A-4 Form 2017 W-4 Form 2017 I-9 Form 2016-2019 BCBS Dental Ins Application 2016 BCBS Health Ins Application 2016 Direct Deposit Agreement Form 2017 2017 Employment Application 2017 401k Auto Enrollment Notice ADA Acknowledgement Form 401k Auto Enrollment Acknowledgement Form Code of Conduct PCI DSS Acknowledgement Form PCI DSS Payment Card Industry Data Security Standards Coding and Billing Policies and Procedures Lister Healthcare Group | 2807 W. Mall Drive, #3, Florence, AL 35630 | Phone: (256) 767-7494 © 2021 Lister Healthcare Group | Powered by Straight 8 Consulting | Privacy Policy

Welcome About Services Practices Announcements Employee Documents Calera Family Healthcare Calera Family Health Services Hours Directions Appointments About Patient Portal Contact Internal Medicine for All Ages Family Practice Our Physicians Proudly Serving the Calera Area Access the Patient Portal 11206 Hwy 25, Calera, AL 35040 | Phone: (205) 668-0941 | Fax: (205) 668-2701 © 2021 Lister Healthcare Group | Powered by Straight 8 Consulting | Privacy Policy

Welcome About Services Practices Announcements Employee Documents Compliance Manual Download the Lister Healthcare Compliance Manual HERE. After reading the manual, please fill out the following form. I certify by checking the box below that I have read, or have had read to me, the Lister Healthcare Compliance Manual; that these policies has been explained to me and that I have had an opportunity to ask questions about these policies.* I Agree Name* First Last Date* MM slash DD slash YYYY Lister Healthcare Group | 2807 W. Mall Drive, #3, Florence, AL 35630 | Phone: (256) 767-7494 © 2021 Lister Healthcare Group | Powered by Straight 8 Consulting | Privacy Policy