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Home Health Care Contract Template

Used 4,872 times

Create a legally binding relationship between you and your medical caregiver by using a home health care contract template to designate his/her responsibilities.

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  1. Templates
  2. Medical Agreements
  3. Home Health Care Contract Template


Home Health Care Contract Template

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1. Basic Information

1.1 Type of Document

(Title) Home Health Care Contract

1.2 Parties Identification

For purposes of this contractual relationship, this home health care contract involves [Client.FirstName][Client.LastName] who is residing at [Client.StreetAddress][Client.City][Client.State][Client.PostalCode], has an ID number (Client.IDnumber), and his/her contact phone number is [Client.Phone] (who will be identified as the client) and (Service.Provider) who has a residence at [ServiceProvider.StreetAddress][ServiceProvider.City][ServiceProvider.State][ServiceProvider.PostalCode], has legal permission number (LegalPermit.Number) to perform this activity, and his/her contact phone number is [ServiceProvider.Phone] (who will be identified as the service provider). Both the customer and the service provider will be considered collectively as the parties.

1.3 Purpose of the Contract

The purpose of this document is to set out the basis under which the relationship between the parties will be conducted in relation to the service provided to [Client.FirstName][Client.LastName] by [ServiceProvider.FirstName][ServiceProvider.LastName], including terms of service, conditions, limitations, and responsibilities.

2. Agreement Between the Parties

2.1 Explicit Authorization of the Client

In consideration of the foregoing and the information exchanged, the parties hereto agree as follows:

Customer authorizes the Service Provider to provide home health care services to (Service.Receiver) at the address of (Service.Receiver.FullAddress). Said service will be performed during the hours between (Service.Hour) and will be performed by (Service.Receiver.EmployeeName).

2.2 Term

The authorization attached to this document for the provision of these Home Health care Services is for a term commencing on (Start.Date), and shall remain in effect for a total of (Time.Period). In the event that either party decides to withdraw from this contract, (Days.Number) days advance notice will be required.

2.3 Service Provider Employee Information

By way of assurance, the service provider indicates that it has all permits to perform this activity in the state of (State.License) under license number (License.Number). In addition, it also certifies that the above named personnel are fully qualified to provide the home health care service under a license issued in the state of (State.EmployeeLicense), indicating their training in nursing care, in addition to any special training required.

3. Provided Services

The service provider shall be responsible for providing fully certified nursing care and nursing services for the care of the (Service.Receiver).

Among the powers granted to the service provider are:

  • Administration of the medications listed here:





  • Provide medical treatment or care as required by the circumstances affecting the patient, including, but not limited to, doctor or hospital visits.

  • To assist (Service.Receiver) in maintaining his/her home and to enable him/her to perform as many of the tasks for which he/she is qualified around his/her home and life.

In addition, the provider may agree to additional tasks previously agreed upon by the parties.

4. Contact Persons

As a responsible party for this contract, the client's information is as follows:





In emergency situations, the service provider shall contact the following person:




Finally, if that person is not available, you may use this alternate option:




5. Payment Agreement

For the performance of this agreement, the customer agrees to make a payment in the form of (Payment.Type) to the service provider. Such payment consists of (Payment.Amount) and will be provided at the beginning of each month.

If any additional services are requested by the customer outside of the scheduled hours or holidays, an additional payment of (Payment.Amount) per hour is due. In addition, any necessary or emergency expenses that the service provider may incur in order to fulfill its tasks must be reimbursed by the client.

For purposes of coverage of a certain amount of the payment around the home health care service, here are the details of the insurance company responsible for it:






6. Additional Clauses

6.1 Confidentiality Clause

The home health care provider fully understands that any private information that has been obtained in the performance of his or her duties with respect to the client, the recipient of the service, the recipient's family, or significant others should not be disclosed for any reason. This information includes but is not limited to medical information, legal, financial, number of assets, profession, etc.

Additionally, this confidentiality must be maintained even after the termination of this contract.

6.2 Force Majeure Clause

If the performance of the activities set forth in this contract by the customer and the service provider is prevented, interfered with, or impeded by causes beyond the control of either party ("Force Majeure"), rendering the service provider unable to perform its function, the service provider shall proceed to notify the customer of the event. As a result, the service provider obligations will be suspended for the duration of the event and will be extended if necessary.

Acts of Force Majeure contemplated for this document include (but are not limited to): epidemics, pandemics, health crises, acts of God, fires, vandalism, storms, medical supply failures, labor strikes, national emergencies, insurrections, riots, or war. The excused party must attempt and demonstrate the efforts made to circumvent such a situation and the impossibility of doing so.

6.3 Severability of the Contract

In the event that any of the clauses named in this contract become null, invalid, or unenforceable, this shall not cause the invalidity of the entire document until the contract itself is terminated. This means that the rest of the clauses will remain in effect as long as it is possible according to the laws of the state.

6.4 Notice Clause

In the event that it is necessary to issue any notice or request for communication of any fact, this may be done either person to person or through the use of electronic mail. In turn, in case of notices of legal proceedings, these may be addressed to the addresses of the parties indicated above.

6.5 Attorney’s Fees Clause

In the event that either party decides to terminate the contract prematurely, all attorney's fees necessary for the termination of the contract shall be paid by this party, in addition to any compensation for damages caused by such termination.

7. Applicable Law

This home health care contract template complies with and shall be governed by the laws found in the state of (State). Any dispute resolution or arbitration must consider the laws of the state of (State) for resolution.

8. Signing

This agreement was signed by the parties on (Signing.FullDate) and shall be effective immediately upon such act.





Home Health Care Contract Template

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