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Caregiver Contract

This document serves as an agreement between the caregiver or caregiving agency and the care recipient.  The following paragraphs detail the minimum expectations of the care recipient while in the caregivers care and or residing in the caregiver’s facility.

As a care facility, we agree to:

  • Provide immediate, 24 hour basic life support and automated external defibrillator resuscitation. Resuscitation must be provided by clinically current state and or nationally certified caregivers, and in accordance with the patients advance directives. Staffing and equipment levels must provide sufficient resources based on patient volume.
  • Provide a continuum of care.  In the event of an acute medical emergency, requiring a 911 response, caregivers are required to provide accurate, current and clinically competent patient report to 911 responders regarding patient’s chief complaint, medical history, medications, allergies and advanced directives, immediately upon 911 responder arrival. This would also apply to any transfer from the facility – be it to another care home or for a non-emergency hospital admission.
  • Provide immediate basic life support for airway and breathing resuscitation. Provide and maintain necessary equipment airway and breathing supplies. In the event of an acute medical emergency, caregivers are required to initiate immediate basic life support resuscitation including supplemental oxygen.
  • Provide sufficient staffing levels for patient care needs such as regular vital sign checks (every 15 minutes in acute settings), appropriate ventilator management, turning of patients regardless of size and weight, appropriate medication administration and other non-specified customer and or patient care needs.
  • Perform regular audits of facility policies and procedures in order to ensure best-practice care.


Care Recipient Signature __________________________                       Date ____________________


Care Provider Signature __________________________                         Date ____________________


Click here to download a copy of this contract.

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