Caregiver Form Application With Database In Santa Clara

State:
Multi-State
County:
Santa Clara
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

Applying for IHSS If you already have Medi-Cal or once you are approved for it, call or visit your county In-Home Supportive Services (IHSS) office to complete an IHSS application. Once IHSS gets the application, a caseworker will contact you and schedule a time to visit your home and understand your needs.

Home Care Aide Application Process Access the Guardian Applicant Portal at . Create an Account by clicking “Register as a new user.” A temporary password will be sent to your email account. Enter Application Information. Retrieve the Live Scan Form.

Apply for In-Home Supportive Services Gather important information. You will need your contact information, date of birth, social security number, and Medi-Cal number. Apply for IHSS. Turn in a completed IHSS application by email, fax, mail, or in-person. Home visit. Service approval. Hire provider(s).

To become a caregiver in California, you need to complete a state-approved Home Care Aide training program (40+ hours), pass background checks through the Home Care Services Bureau (HCSB), obtain HCA certification, and complete mandatory safety and infection control training.

The California Family Rights Act (CFRA) is a law that allows family caregivers in California to take job-protected leave away from work to provide care without fear of losing their job. The law applies to individuals in California who meet the following requirements: Employed by a company with five or more employees.

Information for Home Care Aides Access the Guardian Applicant Portal at . Create an Account by clicking “Register as a new user.” A temporary password will be sent to your email account. Enter Application Information. Retrieve the Live Scan Form.

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.

Postal service: IHSS, PO Box 11018 San Jose, CA 95103-1018. Fax: (408) 792-1601. In-person: 353 W. Julian Street, San Jose.

To enroll as an IHSS Provider: Go to the IHSS Independent Provider Enrollment Center for Santa Cruz County Website. Click on the “Start” button and complete the Provider Information section. Click on the “Watch the Orientation Video” button and watch the mandatory provider videos.

Contact IHSS at (408) 792-1600 or fill out the application and submit using one of the options below. Mail. In-Home Supportive Services. PO Box 11018. San Jose, CA 95103-1018.

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Caregiver Form Application With Database In Santa Clara