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 Sample For Veterans In San Antonio
Category:
State:
Multi-State
City:
San Antonio
Control #:
US-00458BG
Format:
Word;
Rich Text
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FAQ
Caregiver Support Program (CSP) The program's mission is to promote the health and well-being of family caregivers who care for our Nation's Veterans, through education, resources, support, and services. Find Your Local Caregiver Support Team located at every VA facility .
Use VA Form 10-10CG to apply for the Program of Comprehensive Assistance for Family Caregivers.
Call the Caregiver Support Line at 855-260-3274 ( TTY: 711 ) and ask for help filling out the form. Find a Caregiver Support Team Coordinator at your nearest VA health facility. Go to our Caregiver Support Program Teams directory. Get help from an accredited representative, like a Veterans Service Organization (VSO).
Veterans can obtain their C-Files by requesting a copy from their local VA Regional Office. Usually, veterans must submit VA Form 3288, Request for and Consent to Release of Information from Individual Records. It can take many months to receive the C-File back from VA after the request is submitted.
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I agree to perform personal care services as the Primary Family Caregiver for the Veteran named on this application. Use this form to apply for the Program of Comprehensive Assistance for Family Caregivers.Eligible Veterans may be able to receive access to an inhome caregiver if they and the person providing care meet certain requirements. This form is used to collect initial intake information for applicants for Older Americans Act caregiver services. In-Home care options and information for veterans. Through the VA's home and community based services, veterans can qualify for nonmedical and medical care at home, as well as other homebased VA programs. In-Home care options and information for veterans. If an individual is not a family caregiver for a veteran, they do not need to fill out VA Form 10-10CG. Providing the correct documentation and filling out the right forms can be overwhelming. Examples include home-delivered meals, attendant care, minor home modifications and day activity health services.