Service Agreement — Award HomeCare

Client Information

First name

Last name

Email

Home phone

Address

Date of birth

Primary physician

HIPAA — Authorization for Release of Medical Information

List anyone Award HomeCare may share medical/care information with:

Name

Relationship

Phone

Name

Relationship

Phone

Terms & Conditions

Nature of Service

This is a day-to-day service agreement — no long-term commitment.
Client may terminate at any time; 24-hour notice required. With less than 24-hour notice, client is responsible for the entire shift.

Deposit & RN Assessment

A two-week deposit is due with this agreement and applied toward the final bill; any remaining amount is fully refundable.
At start of care the RN performs an assessment, with a follow-up every 60 days. Cost is $75/hour per assessment.

Billing & Payment

Award HomeCare invoices and charges the payment method on file every other Monday after services are rendered.
An invoice is automatically emailed to the billing contact on file. Please check spam/junk; search "invoice" if you can't find it. If no invoice arrives by Tuesday of a billing week, call the office.
Payment is due within 5 business days after the prior week's services. Late fees may apply (never exceeding legal limits).
Electronic check is preferred; credit cards accepted with a 3% fee.
Services are billed by schedule, checklist, or electronic/paper timesheet (signed by client and employee).

Rates & Overtime

Hours over 40/week for a specific caregiver are billed at 1.5× the standard rate.
Observed holidays are billed at time and a half (New Year's Eve/Day, Easter, Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas Eve/Day).
Emergency visits, changes in condition, or requested evaluations are billable at a minimum skilled rate of $75/hour.
Rates may change with a 5% annual increase on January 1 for clients starting before November 1 of the prior year, and for changes in care level, hours, location, or wage laws.

Non-Solicitation

Caregivers/RN/LPN are employees of Award HomeCare and may not be hired directly by the client during the agreement and for one (1) year after termination. Violation carries a $25,000 lost-opportunity charge.

Other

Award HomeCare does not provide pet care and is not responsible for animals in the home.
If a caregiver uses their own vehicle for services, the client is charged the IRS mileage rate. Use of the client's vehicle requires the client to maintain valid auto insurance.
Award HomeCare may terminate without notice if staff safety is in jeopardy, or with 72 hours' notice for non-payment.
Some downtime during shifts is normal and expected.

Live-in caregivers are subject to additional terms (12 hours/day worked, 8 hours sleep, meal/break periods) provided at signing.

Non-Medical Services

Award HomeCare provides non-medical (non-skilled) home care — companionship, homemaker, and personal care assistance. Aside from the RN assessment and supervision described above, Award HomeCare is not licensed to provide skilled medical or nursing services, and caregivers do not perform skilled medical procedures.

Governing Law & Dispute Resolution

This Agreement is governed by the laws of the State of New Jersey, and venue for any dispute shall be in Ocean County, New Jersey.
The parties agree to attempt in good faith to resolve any dispute through mediation before initiating legal action.

Entire Agreement

This is the entire agreement between the parties and supersedes any prior discussions. It may be amended only in a writing signed by both Award HomeCare and the Client / Responsible Party.
By signing, the Client / Responsible Party acknowledges they have read, understood, and agree to all terms and conditions of this Agreement.

I understand a two-week deposit is due with this agreement. I have read and agree to the Award HomeCare Terms & Conditions above.

↑ Scroll to the bottom of the terms to enable the agreement checkbox.

Consents & Authorizations

The first four are required to begin services. The rest are optional.

I consent to receive care from Award HomeCare and authorize the use and disclosure of my health information as needed to coordinate and provide services (HIPAA). I acknowledge the Client Bill of Rights & Responsibilities and the Grievance Procedure. I have been informed about Advance Directives and Award HomeCare's responsibility to honor them. I consent to use my electronic signature to sign this agreement and related documents.

(Optional) Award HomeCare may contact me by phone call, text message, and email about scheduling, care, and billing. Message/data rates may apply; reply STOP to opt out of texts.

Photo / Media Release (optional)

Yes, I authorize No

Permission to take photos for care documentation and internal use.

Testimonial Release (optional)

Yes No

Permission to use my feedback in Award HomeCare marketing.

Signature

Client / Responsible Party — type full name

Date

Typing your name constitutes a legally binding electronic signature.