Caregiver Form Application With Database In Minnesota

State:
Multi-State
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.
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  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent
  • Preview Personal Care Service Agreement - Caregiver for Elderly or Disabled - Consent

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FAQ

MinnesotaCare is for families with income at or below 200% of the Federal Poverty Guidelines (FPG) ($30,120 per year for an individual; $62,400 for a family of four), but above 138% of FPG ($20,783 for an individual; $43,056 for a family of four). MinnesotaCare counts most types of earned and unearned income you have.

The HCAPP (DHS-3417) allows people to apply for any or all of the Minnesota Health Care Programs (MHCP) on one form. Questions on the HCAPP may apply to all health care programs, only to one or two programs, or to specific populations.

Once an application is deemed complete MDH has 60 days to issue or deny the temporary license.

Minnesota law requires all individual personal care assistance (PCA) providers to take the Department of Human Service's (DHS) Individual PCA training and pass a one-time online test. Individual PCAs may take the training and test as often as needed.

It is online at .applymn.dhs.mn. ApplyMN is a "smart application" that only asks questions based on the program(s) requested, the household composition and an applicant's response to previous questions.

They can also call the Minnesota Health Care Programs Member Help Desk at 1-800-657-3739 or 1-651-431-2670 to request an application, or they can download an application here. They can also apply in person at their local county office or tribal human services office.

Minnesota home care providers are licensed by the Minnesota Department of Health (MDH). There are two license options available from the Home Care and Assisted Living Program: Comprehensive and Basic.

How long can I expect the Minnesota medical licensing process to take? On average, you can expect the full Minnesota medical licensing process to take approximately four to five months.

15 working days for a pregnant person. 60 days for people requesting an MA eligibility determination under a disability basis of eligibility. 45 days for all other applicants.

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Caregiver Form Application With Database In Minnesota