Agency:
Home Care Service Agreement
Between ______ ("Agency") and ______ ("Client"). Responsible party: ______.
1. Services. Agency will provide the non-medical services listed in the attached care plan. Caregivers do not provide medical services or administer medication. Caregivers are employees of Agency.
2. Schedule. Starting schedule: ______. Changes may be requested with 48 hours' notice.
3. Rates. Standard: $____/hour. Minimum visit: ____ hours. Weekends: $____/hour. Holidays (listed in Schedule A): $____/hour. Overnight: $____/hour. Live-in: $____/day.
4. Overtime. When Client requests that one caregiver work more than 40 hours in a week, hours over 40 are billed at $____/hour.
5. Cancellations. Client will give ____ hours' notice to cancel a visit. Visits cancelled with less notice are billed at the minimum visit length.
6. Billing and payment. Agency invoices every ______. Payment is due within ____ days by ______. A deposit of $____ is due before the first visit and applied to the final invoice.
7. Late payment. Balances unpaid ____ days after the due date incur a fee of ____. Agency may suspend service after ____ days' written notice.
8. Rate changes. Agency will give 30 days' written notice of any rate change.
9. Termination. Either party may end this agreement with ____ days' written notice. Agency may stop service immediately if caregiver safety is at risk.
10. Hiring caregivers. If Client hires an Agency caregiver directly within ____ months, a placement fee of $____ applies, where allowed by law.
Client or representative: ______ Date: ______
Agency: ______ Date: ______