In accordance with Pennsylvania state regulations (35 Pa. Stat. § 448.806b),

• I am not permitted to endorse a check over to a home care agency or registry, including Silver Home Care.
• e.I am not permitted to give or assign power of attorney to anyone employed by or affiliated with Silver Home Care.
• I am not permitted to give or assign guardianship to anyone employed by or affiliated with Silver Home Care.

I have been provided with the opportunity to ask questions and understand my responsibility to comply with all relevant laws, regulations, and contract provisions.

I acknowledge that failure to comply may result in the termination of services provided by Silver Home Care

35 Pa. Stat. § 448.806b: "No individual as a result of the individual's affiliation with a home care agency or home care registry may assume power of attorney or guardianship over a consumer utilizing the services of that home care agency or home care registry."

35 Pa. Stat. § 448.806b: "No consumer may be required to endorse checks over to a home care agency or home care registry.