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 Database In Alameda
Category:
State:
Multi-State
County:
Alameda
Control #:
US-00458BG
Format:
Word;
Rich Text
Instant download
Description
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FAQ
To be eligible for GA, you must: Be a county resident. Be age 18 or older, or. An emancipated minor, or. A child under age 18 who has no means of support. (There are special rules for children. Be low-income. Be a citizen or have legal immigration status. Follow the county rules.
If you would like to apply over the phone, call us at (510) 272-3663. If you need an application packet to be mailed to you, call us at (510) 272-3663 or 1-888-999-4772.
MY PHONE: Call 510-577-1800 weekdays from AM - 12 Noon or - PM. Once you dial, when prompted, press “1” for English and then “1” for applying for IHSS and “1” a third time to speak with an intake screener. 2. BY MAIL: Request an application to be mailed to client's home.
To be eligible for IHSS, an individual must be Medi-Cal eligible or must be receiving Supplemental Security Income (SSI) benefits. The IHSS program provides payment for non-medical in-home care for qualified individuals who are unable to remain safely in their homes without this assistance.
General Assistance/Relief Most people can get GA payments for 3 months out of a 12 month period. People who cannot work due to a disability ("unemployable") can continue to get GA benefits longer than 3 months.
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Blank Application Forms. The below forms may be dropped at a secure drop box, at one of our offices, during regular business hours, am to pm.You must first complete an enrollment application. Please contact us at to request an application packet in English, Chinese or Spanish. All three populations will be included in a new data-sharing and care coordination system. This form is for Alliance members who are UNDER THE AGE OF 21. If you believe that your patient may be appropriate for ECM services, please complete this form. Call for more information. If you are interested in joining the AHS Homeless Health Center CAB, reside anywhere in Alameda. An applicant must submit a completed application packet to the Centralized Applications Branch (CAB).