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.
Application Caregiver Form With Child In Riverside
Category:
State:
Multi-State
County:
Riverside
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
You May Be Eligible For IHSS If You: Are 65 years of age, disabled or blind. Have a functional impairment and are at risk for out of home care placement.
To become a caregiver in California, meet state requirements (work authorization, background check, good health), complete a Home Care Aide certification course and provide proof of vaccinations and a negative TB test.
Become a Provider Step 1: Set up Your Account. Visit the IHSS enrollment website and. Step 2: Get Fingerprinted. Step 3: Attend the In-Person Orientation. Step 4: Fill Out and Return the SIP Packet. Step 5: Create an Online Account.
How to Become an IHSS Provider Go to an IHSS Provider Orientation given by the county. Complete, sign and return the IHSS Program Provider Enrollment Form (SOC 426) directly to the County IHSS Office or IHSS Public Authority. Complete and sign the IHSS Provider Enrollment Agreement (SOC 846) .
Process Step 1: Set up Your Account. Visit the IHSS enrollment website and. Step 2: Get Fingerprinted. Take your Live Scan form to any Live Scan location to complete your fingerprint background check. Step 3: Attend the In-Person Orientation. Step 4: Fill Out and Return the SIP Packet. Step 5: Create an Online Account.
To apply for IHSS over the phone, contact Riverside's HOME Call Center at (888) 960-4477. Phones are answered Monday – Friday from AM to PM Pacific time, excluding County holidays.
Who is Eligible? Be disabled, blind, or age 65 years or older. Be unable to live at home safely without help. Meet the program's financial need requirements. Financial Need Requirement. Do You Qualify?
To apply for In-Home Supportive Services (IHSS): Call: 714-825-3000 during business hours (Monday – Friday am – pm) Fax: Fax completed applications to 714-825-3001. Mail: Mail completed applications to P.O. Box 22006, Santa Ana, CA 92702.
Orange County IHSS Public Authority Provider/Caregiver Services Must follow the application process. Attend Registry Orientation. Submit a complete application. Must be willing and able to provide personal care and perform domestic services. Must own an insured and dependable car. Must be able to speak/read/write English.
Of those who do get approved, it can take anywhere from two weeks to several months to finally receive benefits. This is due to the meticulous amount of paperwork involved, as well as the process of the case worker assessment, background check, and other procedures.