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 Application Form With Insurance In Harris
Category:
State:
Multi-State
County:
Harris
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
What is the Harris Health Financial Assistance Program? The Harris Health Financial Assistance Program is a program that is available to Harris County residents whose gross family income, as it relates to family size, falls at or below at or below 150% of the Federal Poverty Level.
To receive Home Health Services, the client must meet one or more of the following criteria: The client needs the aid of supportive devices, such as crutches, canes, wheelchairs, or walkers. The client has a condition in which leaving the home is medically contraindicated.
What to Include in a Checklist for Caregivers Name of caregiver on duty. Date the checklist is being used. Name of patients. Patient's morning, afternoon, and evening routines, such as: Taking medication and vital signs. Eating food and drinking water. Housekeeping tasks to do. Changes in patient's condition, if any.
Emphasis on Role: “Caregiver” and “carer” emphasize the act of giving care, with a focus on the practical and emotional work involved. “Caretaker” suggests a more functional or managerial role, often with a broader focus on property or task management.
The Harris Health Financial Assistance Program is a program that is available to Harris County residents whose gross family income, as it relates to family size, falls at or below at or below 150% of the Federal Poverty Level.
Harris Health Financial Assistance Program (Gold Card) Texas I.D. or drivers license stating the person lives in Harris County. Social Security Card. Citizenship(Passport or Birth Certificate) or Green Card. Proof of income (1 months check stubs) Any bills or bank statement (within 60 days) Income tax (if necessary)
ACCESS Harris County works with community members experiencing hardships, including health challenges (physical and/or mental), financial and housing needs, substance abuse, and social inequity by providing intensive, wraparound support across Harris County's safety net system.
Harris Health Financial Assistance Program or the status of my application, is there a phone number to call? For questions call 713-566-6509 (Monday – Friday, 8am – 4pm) to speak to the Eligibility Call Center team member for any questions regarding the Harris Health Financial Assistance Program.
How do I renew my Harris County Gold Card? Gold Card Renewal Application To reapply you will need to complete a Harris Health application. This application is the exact same document that you completed when you first applied for Gold Card coverage.