This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Caregiver Form Application With Medicare In Queens
Category:
State:
Multi-State
County:
Queens
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
Definitions. Parents of Dependent Children: Income limits for 2024 are reported as a percentage of the federal poverty level (FPL). The 2024 FPL for a family of three is $25,820. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2024 FPL for an individual is $15,060.
If you are pregnant or applying on behalf of children, a determination should be made within 30 days from the date of your application. If you are applying and have a disability which must be evaluated, it can take up to 90 days to determine if you are eligible.
Call the New York State Health Department's Growing Up Healthy Hotline at 1-800-522-5006, or contact your local county Department of Social Services. In New York City, call the Information Hotline at 311 or (718) 557-1399.
If you are pregnant or applying on behalf of children, a determination should be made within 30 days from the date of your application. If you are applying and have a disability which must be evaluated, it can take up to 90 days to determine if you are eligible.