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 Medicaid In Phoenix
Category:
State:
Multi-State
City:
Phoenix
Control #:
US-00458BG
Format:
Word;
Rich Text
Instant download
Description
Free preview
Form popularity
FAQ
Certification Requirements in Arizona Be at least 18 years old. Possess a high school diploma or GED. Complete a caregiver training program approved by the DHS. Pass a written competency exam. Obtain a fingerprint clearance card from the Arizona Department of Public Safety (DPS)
At the latest, 45 calendar days from the application date.
In Arizona, our caregivers are certified with a “Direct Care Worker” certification overseen by the state AHCCCS program. In Colorado, our caregivers meet the state requirements for experience and must pass a hands-on care assessment before coming onto the team.
Eligibility 60 years of age or older, or. 18 - 60 years of age with a disability, and functionally impaired and unable to perform activities of daily living. This includes eating, bathing, dressing, grooming, using the bathroom and mobility (for example, walking or moving from a wheelchair to a bed).
To work as a certified caregiver in Arizona, you must meet the following requirements: Be at least 18 years old. Possess a high school diploma or GED. Complete a caregiver training program approved by the DHS. Pass a written competency exam.