Filipino Homecare Client Contract

Filipino Homecare Client Contract
Client

First NameLast Name
Age
Address/Location where services are to be provided

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
TERMS AND CONDITIONS:

This Home Care Contract is entered between the Client mentioned above and Filipino Homecare. The Client and Filipino Homecare shall be collectively known herein as the "Parties"

Whereas, the purpose of this Contract is to set out the "Terms of Service" to be provided to the Client by Filipino Homecare.

IN consideration of the mutual promises and other valuable consideration exchanged, the Parties hereby agree and Contract as follows:

1. AUTHORIZATION. This Contract hereby grants Filipino Homecare the authority to provide Home Health Care Services to said Client at their home at the address provided on this Contract.

2. TERM. This grant of Authorization to provide Home Health Care Services shall begin on the Date mentioned below, and shall remain in effect until the Client no longer requires Filipino Homecare Services. The Terms of this Contract may not be changed by either Party without at least 48hrs notice, exceptions include Hospitalization,Termination of this Contract requires 2 weeks Notice. The Worker has a Fixed amount of hrs per visit (4hr minimum), if the Client tells the Worker that she can go home early, the Client will still be billed for the Scheduled amount of hrs. Scheduled Days and Hrs shall not be changed or cancelled without 48hrs written notice to Filipino homecare Ltd.

3. LICENSING. The Service Provider warrants that, Service Provider is Licensed in Canada to provide the Services mentioned in this Contract. Further, any Employee or Representative performing Services under this Contract is a Licensed PSW in the Province where services are being provided, and is current in all Training and Certifications

4. TRANSPORTAION/ACCOMPANYMENT ON OUTTINGS. When required, the PSW may accompany the Client to Appointments where transportation is provided at the Clients expense, Insurance doesn't allow PSW's to use their own vehicle to transport Clients to appointments.

Of course the PSW will do everything in their Power to ensure a Safe, incident free experience while being out with the Client, however, neither the Worker or Filipino Homecare is in anyway responsible for any mishap, or incident.

Should the Client require Medical assistance, the Worker will call the Emergency Contact and or 911 to arrange an Ambulance on the Client's behalf.
5.Worker Exclusivity: Workers are under Contract with Filipino Homecare Ltd.

The Client agrees to respect Filipino Homecare's Contract with Workers, barring them from approaching and/or hiring Workers Privately for the duration of said Contract, or until this Contract is terminated. This clause is in effect for the duration of the Contract + 6 months following the termination of the Contract or "last day worked".

If the Client wishes to buyout the Workers Contract, or if the Client employs said Worker privately, the Buyout or Penalty, shall be a Minimum of 2 weeks of the regular Invoiced amount, or $2500, whichever is greater.
Services to begin on:

MonthDayYear
Date

Care Plan

	Required
1.Bathing
2.Assist Dressing.
3.Personal Hygiene
4.Eating
5.Meal Preparation
6.Light Housekeeping
7.Assist with Exercise and Mobility
8.Supervise/Remind Client to take Medication
9.Accompany Client to Appointments (Not using Workers own Vehicle, Client pays for Workers Transportation)

Schedule for Services required (4 HR Minimum, check all that apply)

	4 HRS	5 HRS	6 HRS	8 HRS	10 HRS	12 HRS	24 HRS
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Client, POA/Companion signing for Client

First NameLast Name
Client or POA/Companion signaturer*

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Witness*

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Amalia Lishinski CEO Filipino Homecare

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Should be Empty:

Filipino Homecare Client Contract

TERMS AND CONDITIONS:

This Home Care Contract is entered between the Client mentioned above and Filipino Homecare. The Client and Filipino Homecare shall be collectively known herein as the "Parties"