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1. Parties: Identification of the care recipient, primary caregiver(s), and person giving consent (if different from care recipient)
2. Background: Brief context of the caregiving arrangement and reason for care
3. Definitions: Key terms used in the document including 'caregiver', 'care services', 'emergency', 'medical decision-making'
4. Scope of Care Services: Detailed description of authorized caregiving duties and responsibilities
5. Consent Declaration: Explicit statement of consent for the specified care services
6. Emergency Procedures: Protocol for handling medical emergencies and authorization for emergency decision-making
7. Privacy and Confidentiality: Obligations regarding personal and medical information handling
8. Duration of Consent: Period for which the consent remains valid and conditions for renewal
9. Termination: Circumstances and process for terminating the caregiving arrangement
10. Signatures: Execution section for all relevant parties including witnesses
1. Medical Authorization: Additional section for cases requiring administration of medication or medical procedures
2. Living Arrangements: Required for live-in caregiver situations, detailing accommodation arrangements
3. Special Care Instructions: For cases involving specific medical conditions or special needs
4. Transportation Authorization: When caregiver needs to transport care recipient to appointments
5. Financial Arrangements: If caregiver handles any financial matters for the care recipient
6. Substitute Decision-Making: For situations where care recipient may become incapacitated
1. Schedule 1 - Care Plan: Detailed daily/weekly care schedule and specific tasks
2. Schedule 2 - Emergency Contacts: List of emergency contacts including medical professionals, family members
3. Schedule 3 - Medical Information: Care recipient's relevant medical history, medications, allergies
4. Appendix A - Authorized Activities: Comprehensive list of specific activities the caregiver is authorized to perform
5. Appendix B - Medication Schedule: If applicable, detailed medication administration schedule and instructions
6. Appendix C - Incident Report Form: Template for documenting any incidents or emergencies
Authorized Representative
Care Plan
Care Recipient
Care Services
Caregiver
Confidential Information
Consent
Emergency Contact
Emergency Situation
Effective Date
Healthcare Provider
Immediate Family Member
Incapacity
Medical Decision
Medical Information
Next of Kin
Personal Care
Personal Data
Primary Caregiver
Professional Services
Registered Medical Practitioner
Resident
Respite Care
Schedule of Care
Service Location
Special Instructions
Substitute Decision Maker
Term
Termination Date
Scope of Services
Consent and Authorization
Medical Care
Emergency Procedures
Confidentiality
Personal Data Protection
Rights and Responsibilities
Health and Safety
Duration and Termination
Liability and Indemnification
Force Majeure
Assignment
Governing Law
Dispute Resolution
Entire Agreement
Severability
Amendments
Notices
Execution
Healthcare
Elder Care
Social Services
Disability Services
Home Healthcare
Medical Services
Residential Care
Community Care
Healthcare Staffing
Legal
Compliance
Healthcare Operations
Human Resources
Quality Assurance
Patient Services
Clinical Operations
Risk Management
Care Coordination
Administrative Services
Caregiver
Home Health Aide
Registered Nurse
Healthcare Administrator
Care Coordinator
Social Worker
Healthcare Compliance Officer
Personal Care Assistant
Case Manager
Healthcare Facility Manager
Medical Director
Quality Assurance Manager
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