Care Contacthome_admin2020-04-16T16:49:43+00:00 [] 1 Step 1 This contract, executed on Name Datedate_range Betweendate_range (Client ) Anddate_range 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-date_range 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 Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Daily Hours Sun Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Daily Hours Mon Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Daily Hours Tue Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Daily Hours Wed Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Daily Hours Wed Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Daily Hours Thur Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Daily Hours Fri Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time Begin000204060810121416182022240030access_time End000204060810121416182022240030access_time 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 Datedate_range Witness Signature Print Name Today's Datedate_range 24/7 Home Support And Care Inc. Signature Print Name Today's Datedate_range Save Form 24/7 Home Support And Care Inc. A North American Home Care Partner keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder