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.
Application Caregiver Form With Decimals In Fairfax
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State:
Multi-State
County:
Fairfax
Control #:
US-00458BG
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Word;
Rich Text
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FAQ
How to Apply. If you think you could benefit from Medicaid, you can apply online at CommonHelp or contact the Enterprise Call Center at 1-833-522-5582. Language assistance is available. If you'd like more information, learn more about applying for Medicaid.
If you have experienced a qualifying event, please notify the Benefits Division at DHRBenefitsDivision@fairfaxcounty or (703) 324-3311.
The Department of Medical Assistance Services (DMAS) rebranded Virginia's Medicaid program as Cardinal Care.
Calling your case worker directly or calling the Customer Call Center at 703-324-7500, Monday–Friday, 8 a.m.– p.m.
Cover Virginia also operates a statewide customer service call center for Medicaid and the FAMIS Programs at 1-855-242-8282. The call center provides general program information, application status, explanation of coverage and benefits, and assistance in resolving application issues.
For example: If an eligible Veteran requires 10 hours of personal care services weekly (Tier 1) and the Caregiver's hourly wage (including COLA) is $10 per hour, then the monthly stipend would be: (10 hours x $10) x 4.35 = $435.
Fairfax County Clerk's Office The Clerk's Office is open from 8 A.M. to 4 P.M., Monday through Friday. It is located at 4110 Chain Bridge Road, Fairfax, VA, 22030. Email: The Clerk's Office answers email during normal business hours. You can email us at GDCMail@fairfaxcounty.
Contact us! 703-FAIRFAX (703-324-7329) (phone, email and social media) is a contact center for general questions from 8 a.m. to p.m., Monday to Friday.
You can also call our office at 703-222-8234, TTY 711 or send an email to DTAPPD@fairfaxcounty.
Virginia Caregiver Training Requirements Home Attendant/Home Health Aide: Must complete a state approved 40-hour curriculum or HHA program of 75 hours and 12 hours CE annually. Certified Nurse Assistants: After completing a state approved CNA school program, CNAs in Virginia must complete 12 hours of CE annually.