Step 1 of 3
I, the undersigned, hereby make the following acknowledgement and agreements pertaining to services to be provided by Abundance Care LLC hereinafter THE AGENCY.
Notify the office, if you would like to make any change to the care identified above. A staff member will contact you and an addendum will be added. In addition, your customized care plan will also be updated and your caregiver will be notified.
THE AGENCY rates for services listed below. The agreed upon rate(s) is/are:
Live- In requires a minimum of (8) hours of sleep. If your level of care does not permit, THE AGENCY will bill you at an hourly rate and may provide (2) employees contingent upon your level of service requested.
I understand the AGENCY will invoice for hourly care weekly in advance for live in service(s). By providing a signature the client agrees to submit a payment within (1) calendar day. All payments may be paid by check or via ACH transfer. A signature is required below and the responsible party will be liable for all collection activity fees, legal fees obtained by THE AGENCY for collecting on delinquent invoices/monies that are owed to the agency. THE AGENCY will apply a 3% fee on all outstanding invoices which are not paid in full within 3 business days. Transportation mileage will be exempt if the client allows the employee to use their personal vehicle. The responsible party will ensure third party fees that may be used for payment of services are received on time. Invoices will be emailed or delivered to the client/ responsible party for payment at the following address or Via email:
Clients may cancel services at any time and will be charged only for services that were actually performed before the cancellation.
The Provider may charge the Client a travel fee and service fee if services are not canceled before the staff member arrives at the Client's home.
I authorize the employees of the Agency to provide care services at the request of myself or a family member.
Before services are provided, the anticipated benefits, possible discomforts, and potential side effects of treatment will be explained.
The Agency is not liable for any results arising from treatment, except where such results are caused solely by the negligence of its staff.
In accordance with Georgia State law, the Agency and its employees are required to report any suspected abuse, neglect, or exploitation of an elderly person.
Staff members are assigned by the Agency based on the Client's individual needs and the care and services required.
The Client understands and agrees to receive services without discrimination based on race, ethnicity, religion, sex, age, veteran status, or disability.
Employees of the Agency may be observed by members of the Board of Directors, healthcare consultants, supervisory staff, nurses, state and accreditation surveyors, and representatives of other certification, accreditation, or professional organizations to ensure quality, ethical care, and compliance with applicable standards.
All observations will be conducted in accordance with ethical care guidelines while maintaining the confidentiality of Client information as outlined in the Notice of Privacy Rights.
By signing this Agreement, the Client grants permission for the individuals listed above to observe Agency staff during the delivery of services to ensure quality and ethical care.
The Client understands that this permission may be revoked at any time, either verbally or in writing.
Access to the Client's funds may be required when home care management services are provided or when assistance is requested with bill payments, shopping, or other authorized service-related activities.
The Agency, located at 132 Stanley Ct., Suite N, Lawrenceville, GA 30046, provides services 365 days a year.
For information regarding Health Care Facility licensing requirements, please contact the Health Care Facility Regulations Division at (404) 657-5850.
To file a complaint regarding provider services, please call (404) 657-5728.
For questions, concerns, or assistance regarding services, please contact Seek2Find Homecare LLC at (678) 835-8795.
