A home health care contract is a document made between a medical professional (usually a nurse or a caregiver) and a client, which contains all the information regarding the activities that this professional must and can perform for the client. In the case of providing care to an elderly person or any other individual, a free home health care contract template is extremely useful in setting up the relationship between the parties regarding medication, treatments, meals, and other terms of service.
(Title) Home Health Care Contract
Include all the basic information about the parties and the formation of the agreement. In this section, an elderly care agreement format should contain as much information as possible about both the client and the service provider so that they can be properly identified in the event of a problem.
For purposes of this contractual relationship, this home health care contract involves [Client.FirstName] [Client.LastName] who is residing at [Client.StreetAddress] [Client.City] [Client.State] [Client.PostalCode] , has an ID number (Client.IDnumber), and his/her contact phone number is [Client.Phone] (who will be identified as the client) and (Service.Provider) who has a residence at [ServiceProvider.StreetAddress] [ServiceProvider.City] [ServiceProvider.State] [ServiceProvider.PostalCode] , has legal permission number (LegalPermit.Number) to perform this activity, and his/her contact phone number is [ServiceProvider.Phone] (who will be identified as the service provider). Both the customer and the service provider will be considered collectively as the parties.
The purpose of this document is to set out the basis under which the relationship between the parties will be conducted in relation to the service provided to [Client.FirstName] [Client.LastName] by [ServiceProvider.FirstName] [ServiceProvider.LastName] , including terms of service, conditions, limitations, and responsibilities.
In this section of the home health care contract template, you’ll add all the information regarding the person receiving the service, the place where it’s located, and the names of the personnel who will perform the service. It’s not necessary that the person found in this document for the contracting of the service is the same person who receives it as long as he/she is legally responsible for the receiver.
In consideration of the foregoing and the information exchanged, the parties hereto agree as follows:
Customer authorizes the Service Provider to provide home health care services to (Service.Receiver) at the address of (Service.Receiver.FullAddress). Said service will be performed during the hours between (Service.Hour) and will be performed by (Service.Receiver.EmployeeName).
Include the start time of the home health care service and its duration. In some cases, the date of completion of the service may be included if the estimated date of completion is available.
The authorization attached to this document for the provision of these Home Health care Services is for a term commencing on (Start.Date), and shall remain in effect for a total of (Time.Period). In the event that either party decides to withdraw from this contract, (Days.Number) days advance notice will be required.
Indicate the license numbers and certificates of the company providing the service and its personnel. In turn, it certifies the personnel as qualified to perform the task, which makes it fully responsible for the service provided by such personnel to the person.
By way of assurance, the service provider indicates that it has all permits to perform this activity in the state of (State.License) under license number (License.Number). In addition, it also certifies that the above named personnel are fully qualified to provide the home health care service under a license issued in the state of (State.EmployeeLicense), indicating their training in nursing care, in addition to any special training required.
Include all the responsibilities given to the service provider to avoid misunderstandings between the parties. You can also leave a section where additional tasks can be agreed upon if both parties agree to it.
The service provider shall be responsible for providing fully certified nursing care and nursing services for the care of the (Service.Receiver).
Among the powers granted to the service provider are:
Administration of the medications listed here:Provide medical treatment or care as required by the circumstances affecting the patient, including, but not limited to, doctor or hospital visits.
To assist (Service.Receiver) in maintaining his/her home and to enable him/her to perform as many of the tasks for which he/she is qualified around his/her home and life.
In addition, the provider may agree to additional tasks previously agreed upon by the parties.
For convenience and security purposes, this section will indicate which person should be contacted in each case. In this way, the customer will be able to solve any problems related to the contract, while the emergency contacts may be the best people to reach at any time when necessary.
As a responsible party for this contract, the client's information is as follows:
[Client.StreetAddress] [Client.City] [Client.State] [Client.PostalCode]
In emergency situations, the service provider shall contact the following person:
Finally, if that person is not available, you may use this alternate option:
For the performance of this agreement, the customer agrees to make a payment in the form of (Payment.Type) to the service provider. Such payment consists of (Payment.Amount) and will be provided at the beginning of each month.
If any additional services are requested by the customer outside of the scheduled hours or holidays, an additional payment of (Payment.Amount) per hour is due. In addition, any necessary or emergency expenses that the service provider may incur in order to fulfill its tasks must be reimbursed by the client.
For purposes of coverage of a certain amount of the payment around the home health care service, here are the details of the insurance company responsible for it:
The home health care provider fully understands that any private information that has been obtained in the performance of his or her duties with respect to the client, the recipient of the service, the recipient's family, or significant others should not be disclosed for any reason. This information includes but is not limited to medical information, legal, financial, number of assets, profession, etc.
Additionally, this confidentiality must be maintained even after the termination of this contract.
The force majeure sections allow the service provider to state the excuses for which your home health care contract can be paused without termination in the event of non-performance. This clause should clearly state the suspension of the service provider’s obligations until the situation has been normalized.
If the performance of the activities set forth in this contract by the customer and the service provider is prevented, interfered with, or impeded by causes beyond the control of either party ("Force Majeure"), rendering the service provider unable to perform its function, the service provider shall proceed to notify the customer of the event. As a result, the service provider obligations will be suspended for the duration of the event and will be extended if necessary.
Acts of Force Majeure contemplated for this document include (but are not limited to): epidemics, pandemics, health crises, acts of God, fires, vandalism, storms, medical supply failures, labor strikes, national emergencies, insurrections, riots, or war. The excused party must attempt and demonstrate the efforts made to circumvent such a situation and the impossibility of doing so.
In the event that any of the clauses named in this contract become null, invalid, or unenforceable, this shall not cause the invalidity of the entire document until the contract itself is terminated. This means that the rest of the clauses will remain in effect as long as it is possible according to the laws of the state.