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Personal Care Service Agreement - Caregiver for Elderly or Disabled -...

Caregiver Form Template For Counseling In Hennepin

Q: What is the phone number for Hennepin County CADI waiver?

This information is available in alternative formats to in dividuals with disabilities by calling (651) 431 2400 or (800) 747 5484. TTY users can call through Minnesota Relay at (800) 627 3529. For Speech to Speech, call (877) 627 3848.

Category:

Contracts - Services

State:

Multi-State

County:

Hennepin

Control #:

US-00458BG

Format:

Instant download

Description

The Caregiver Form Template for Counseling in Hennepin serves as a vital agreement between clients and caregivers, outlining the specific terms of employment and the assistance provided. This template allows users to designate the caregiver's responsibilities, including aiding with daily living activities, scheduling medications, and attending appointments. One of its key features is the stipulation that changes to the agreed schedule require a notice of at least 48 hours. The document also includes provisions for termination of the agreement with two weeks' written notice. It emphasizes that caregivers are independent contractors, ensuring no employer-employee relationship exists. Additionally, it provides for the reimbursement of reasonable attorneys' fees in case of any breaches of the agreement. This form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants, enabling them to facilitate caregiving arrangements while protecting both parties’ rights. Users can easily fill in the customizable sections for names, addresses, and compensation details, making it straightforward to complete and edit.

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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.

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FAQ

This information is available in alternative formats to in‑ dividuals with disabilities by calling (651) 431‑2400 or (800) 747‑5484. TTY users can call through Minnesota Relay at (800) 627‑3529. For Speech‑to‑Speech, call (877) 627‑3848.

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.

Call 612-348-3000, Monday through Friday, 8 a.m. to p.m.

Arc Guide to the Community Access for Disability Inclusion (CADI)... Be eligible for Medical Assistance (MA) Be certified as disabled by the State Medical Review Team (SMRT) or Social Security. Be under the age of 65 when the waiver begins.

Where can I learn more about the Elderly Waiver? More information is available on the Minnesota Department of Human Services website, mn/dhs, and in Minnesota Statutes 256B. 0915. Information is also available by calling the Senior Linkage Line at 800-333-2433 or going to MinnesotaHelp.info.

For all other questions about our Home-Based or PCA Services, please call us at (612) 706-5511 or email actg@actg.

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.

This document is a Request for Medical Opinion form needed for medical evaluations related to public assistance eligibility. Users must fill out their personal and medical provider information accurately.

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Call 1-866-333-2466.