Care Contact

A North American Home Health Agency

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This contract, executed on 

Name
Date
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Between
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(Client ) And
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24/7 Home Support And Care Inc.:

24/7 Home Support And Care Would Commence Your Care And Would Continue Until A Written One Month Notice To STOP CARE Is Received From You.

START DATE D--M--Y-
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CARE SITE ADDRESS
CARE SCHEDULE
The following represents a typical schedule. 24/7 Home Support And Care Would Try As Much As Possible To Minimize Unforeseen Fluctiations
Sat
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Daily Hours
Sun
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End
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End
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Daily Hours
Mon
Begin
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End
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Begin
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End
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Daily Hours
Tue
Begin
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End
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Begin
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End
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Daily Hours
Wed
Begin
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End
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Begin
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End
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Daily Hours
Wed
Begin
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End
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Begin
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End
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Daily Hours
Thur
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End
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Begin
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End
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Daily Hours
Fri
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Daily Hours
Total Daily Hours


NOTES ABOUT THE PERSON REQUIRING CARE The Client Requiring Care 

Client Name
NAME AND DOB
has been diagnosed with (Include any essential information about dementia, Alzheimer's, food allergies, chronic pain or other chronic conditions).
The Client can/cannot be left alone . Client Has Dog/Cat. Client Is A Smoker Client Has AllergiesClient's Initial
JOB RESPONSIBILITIES
Here are some of the things 24/7 Home Support And Care Inc. Will Be Responsible For In This Contract( Please Indicate Yes/No)
Health Care(Medical Care)
[These services should be provided by a licensed therapist or nurse. It is advised to ask to see the current license and make a copy.]
Speech therapy
Wound care or bandaging
Rehabilitative or therapeutic physical therapy
Occupational therapy
Blood Pressure Monitoring(OD/ BID/TID)
Blood Sugar Monitoring(OD/BID/TID/QID)
Medication Administration
Non Medical Care
Medication prompting
Bedroom
Help with transfers (getting in and out of bed)
Change bed sheets
Straighten room, make bed
Personal Care
Assist with transfers (going from chair to bed, using the toilet, getting in and out of the bath, etc.)
Assist with bathing
Assist with toileting
Assist with dressing
Assist with walking
Assist with exercises
Assist with shaving
Assist with personal grooming (brushing hair or teeth, clipping fingernails or toenails)
Observe and record any health or behavior changes
Meals and Nutrition
Plan meals and snacks a day
Prepare food
Serve food
Provide company at mealtime
Assist with feeding
Clean dishes or put in dishwasher
Put away clean, dry dishes
Wipe surfaces of counters and stove
Activity of daily living
General Duties
Clean tub, toilet, sink
Care for pets
Empty trash in kitchen, bathrooms and bedroom
Sort recycling items
Secure home when leaving
General/thorough house cleaning
Wash, dry, fold and put away laundry
Water plants
Vacuum carpets and floors or sweep hard floors
Shovel or de-ice steps
Garden maintenance
Keep home surfaces clean, clutter-free and dusted
Grocery Shopping, Errands and Activities
Errands may include stops at the grocery store, drug store or gas station to purchase food and supplies
Put items away in the home
Transportation
Arrange for alternate transportation (like a senior van) or public transportation
Medical or dental appointments
Beauty or personal care appointments
Social visits to family and friends
Faith-based visits
Social Pursuits
Reading out loud
Playing games (board, card, etc.)
General companionship and conversation
Additional timelines and instructions are attached in the Adult and Senior Care Rules and Daily Schedule.
Additional timelines and instructions Is Possible For Seniors Rules and Daily Schedule.
COMPENSATION (Non Medical Care Giving And Home Making)
Regular Rate of pay = per hour
Overtime rate of pay = $_Double Time per hour (for more than 40 hours in a week) And If Caregiver Stays More Than Contracted Time.
Statutory Holidays Rate Of Pay=Time And Half.
Invoice Is Issued For The Amount Of Hours Of Care Contracted And Due Prior Care Commencement .Thereafter Monthly Invoice will Be issued For Payment On The First Of Every Month
There Is A $50.00 Charge For Late Payments ,Returned payments and Non Sufficient Funds.
CANCELLATION POLICY;
Client Can Cancel Care Provider's Contract With A Hand Written One Month Notice To STOP CARE Regular Charges Would Continue If No Notice To STOP CARE.
24/7 Home Support And Care Appreciates And Accommodates Flexibility, We Ask For 48 Hours To Make necessary Changes To Fit Your Schedule.
Client's Signature
Print Name
Today's Date
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Witness Signature
Print Name
Today's Date
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24/7 Home Support And Care Inc. Signature
Print Name
Today's Date
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24/7 Home Support And Care Inc.
A North American Home Care Partner
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