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.
Caregiver Form Template With Pictures In Montgomery
Category:
State:
Multi-State
County:
Montgomery
Control #:
US-00458BG
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Word;
Rich Text
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A formal agreement among family members can provide a way to compensate a person providing care if he or she is no longer able to hold other employment. Please complete all sections below.O Last student entering should bring the patient's chart. Licensing forms are available as printable PDF documents below. They must be completed manually. You can use these forms to submit medical evidence from your health care providers. This information helps to support your claims for disability benefits. Forms and Applications. If using a mobile device to complete any of these forms, you may need to download a free PDF reader. NSM provides 360-degree Complete Mobility Solutions, from customizing wheelchairs to installing chair lifts or repairing your equipment.