Caregiver Application Form With Insurance In Middlesex

State:
Multi-State
County:
Middlesex
Control #:
US-00458BG
Format:
Word; 
Rich Text
Instant download

Description

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.
Free preview
  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent
  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent

Form popularity

FAQ

The New Jersey Personal Preference Program (PPP) offers a way for NJ FamilyCare/Medicaid members, who qualify for the Personal Care Assistant (PCA) service, to remain in their home, active in their community, and does not require the use of a home health care agency.

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.

Trusted and secure by over 3 million people of the world’s leading companies

Caregiver Application Form With Insurance In Middlesex