Home Healthcare Agreement
This document outlines an agreement for in-home healthcare services between a Healthcare Agent and a Patient or their medical proxy. It details the schedule, duration, and scope of services, including payment terms and conditions for termination. The agreement also covers the Healthcare Agent's qualifications and patient consent for access to the property.
Home Healthcare Agreement
[name of healthcare agent] (hereafter “Healthcare Agent”) and the patient or their medical proxy, [name of patient] (hereafter “Patient”), hereby agree to the following:
Beginning [date], the Healthcare Agent will provide in-home healthcare to the Patient at [address] every [days of the week] from [time] to [time 1]. This agreement will last until [date 1], at which time it may be renewed or renegotiated. Either party may end this agreement with [number] days’ written notice.
The Healthcare Agent confirms that [he/she] has completed [certification/training] and has at least [amount of time] work experience as a home healthcare provider.
The Patient confirms that [he/she 1] consents to home healthcare, including granting access to [areas of home] to the Healthcare Agent. If the Patient is physically or mentally unable to communicate [his/her] needs, [name], the medical proxy, is legally equipped and permitted to make decisions on the Patient’s behalf.
The Healthcare Agent will be given [keys/access cards/alarm codes] to the property at [address 1]. In the event that the agreement ends, the Healthcare Agent will return all physical property and equipment belonging to the Patient within [amount of time 1].
The Healthcare Agent will provide the following services and any accompanying or related services as needed: [services]. This does NOT include the services such as [services 1].
The Patient will pay the Healthcare Agent [amount] every [frequency]. This amount will cover all services rendered by the Healthcare Agent except holiday hours, overtime, and additional services not outlined in this agreement. In the event that the Healthcare Agent works holiday hours, overtime, or additional services, [he/she 2] will be paid [amount 1] per hour for the duration of that work.
The Healthcare Agent agrees to follow all legal and medical requirements as outlined by [his/her 1] medical training as well as state and federal law. Both parties agree to treat each other with mutual kindness and respect.
Emergency contacts for the Patient are as follows: [contacts for family, doctor, etc.].
In witness to their agreement to the terms of this contract, the parties affix their signatures below:
____________________________________ _________________________________
[healthcare agent], [patient]
[signature] [signature 1]
[date 2] [date 3]
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