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.
Care Caregiver Form Application With Database Example In Middlesex
Category:
State:
Multi-State
County:
Middlesex
Control #:
US-00458BG
Format:
Word;
Rich Text
Instant download
Description
Free preview
Form popularity
FAQ
The persons, agencies and organizations with which a caregiver has contact – directly or indirectly – are referred to as a person's social support system. Social support may be provided in the form of: Physical or practical assistance (e.g., transportation, assistance with chores)
JACC is a State-funded program that provides a broad array of in-home and community-based services to individuals age 60 and older who meet clinical eligibility for nursing home level of care and who desire to remain in their homes within the community.
More info
Forms to Complete: (We will accept and we appreciate completed forms prior to your visit). â–¡.