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 Hennepin
Category:
State:
Multi-State
County:
Hennepin
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
How to submit forms and documents and update your information Update information and upload documents to InfoKeep. Upload to MNbenefits. Fax to 612-288-2981. Mail to: Hennepin County Human Services Department. P.O. Box 107. Minneapolis, MN 55440.
Call 612-348-3000, Monday through Friday, 8 a.m. to p.m.
Disability HUB MN offers assistance for people under 65 with disabilities. Call 1-866-333-2466. Hennepin County Front Door allows you to talk to a county staff member about your options, including referrals and information.
Apply for health care assistance Most people can apply online at MNsure or call 1-855-366-7873. People 65+ and people with a disability: Download and complete an application and submit to Hennepin County.
Who do I report a change to? If someone in your household gets MA, report a change to your county or tribal agency. If no one in your household gets MA, but someone in your household does get MinnesotaCare, report a change to DHS Health Care Consumer Support at 800-657-3672 or 651-297-3862.
Apply for benefits Apply for economic benefits whenever, wherever. Apply online or call 612-596-1300 Monday through Friday, 9 a.m. to 4 p.m.
Medicaid. A state and federal program (called Medical Assistance in Minnesota) that provides health insurance that covers a broad array of health services for people, including families and children with low-incomes, older adults and people with disabilities.