Care Service Agreement
This FAMILY CARE PLAN gives families the flexibility of PSW care on weekends and holidays, daily care notes and direct line to our Registered Practical Nurse (RPN)
Effective as of the date of signature below (“Effective date”), I/we, as Client/Substitute Decision Maker (“SDM”), hereby authorize Universal Health Hub to provide the services as indicated below (Appendix 1), to the following individual:
I, Client/SDM, have executed this Consent in relation to the services indicated below (Appendix 1), and I understand the services will be invoiced at the Personal Support Worker rate of
$32 per hour + Hst + parking (if applicable)
Rates: (1) are stated in Canadian Dollars; (2) stated exclusive of applicable taxes; and (3) may be subject to change in accordance with federal and/or provincial directives, regulations and/or legislation effective as of the date that such change becomes effective, and/or upon thirty (30) days prior written notice by Universal Health Hub. Applicable federal and provincial taxes will be invoiced. Overtime charges may apply based on provincial standards.
INVOICES; PAYMENT; CHARGES; DISPUTE OF INVOICE; CREDIT INFORMATION
1. Invoices are due and payable upon receipt. If invoices remain unpaid three(3) days from the date of invoice, Universal Health Hub reserves the right to suspend services until payment is received and to notify 3rd party payors/funding partners of non-payment and suspension of services. For clarity, suspension of services shall not prevent Universal Health Hub from pursuing other recourse.
2. Interest charges, collection fees, bank charges ($25.00 for each payment returned by the bank), attorney’s fees and applicable taxes are the responsibility of the Client/SDM.
3. Client/SDM shall inform Universal Health Hub of invoicing disputes within five (5) days of date of receipt of invoice. Disputes reported after such period shall be disregarded and Client/SDM shall be responsible for full payment of invoice.
RESCHEDULING AND CANCELLATION OF SERVICES; TERMINATION OF SERVICE AGREEMENT
Services may be rescheduled or cancelled by contacting Universal Health Hub office with a minimum of twenty four (24) hours’ prior notice or such other minimum notice as may be required by applicable law. In the event that the minimum notice of twenty four (24) hours is not provided, Universal Health Hub shall invoice the Client for the scheduled service.
Client/SDM may terminate this Service Agreement by providing twenty four (24) hours’ notice at any time without cause. Universal Health Hub may terminate this Service Agreement at any time without cause by providing at least three (3) calendar days prior written notice or such other minimum notice required by applicable provincial law. Universal Health Hub may terminate this Service Agreement with immediate effect in order to protect the Client or Universal Health Hub staff providing the service (including in the event of the Client/SDM’s breach of the Privacy section of this Agreement), or to comply with legal or regulatory requirements. In the event of termination by either party for any reason, the obligations contained in this Service Agreement shall survive such termination.
1. Client/SDM shall pay for all services that are not otherwise covered by government/ funding partner/ insurance provider.
2. Client/SDM is responsible for ensuring that insurance policy maximums are not exceeded, and for paying Universal Health Hub for any services rendered beyond such maximums in recognition that Universal Health Hub has no access to insurance policy maximums and/or balances.
3. Universal Health Hub assumes no responsibility for ensuring any insurance coverage or payment of benefits.
NON SOLICITATION – Client/SDM agrees not to solicit or hire any Universal Health Hub personnel providing the Services for up to twelve (12) months from the date of termination of this Agreement.
FORCE MAJEURE – Universal Health Hub shall not be responsible for delays or non-performance by Universal Health Hub due to force majeure circumstances beyond the reasonable control of Universal Health Hub, including without limitation acts or any order of government, outbreak, endemic, pandemic, fire, flood or other natural disaster, accidents, strikes or other labor disturbances, shortages of supplies or equipment, shortages of fuel, inability to obtain or delays of transportation facilities, incidents of war, or other similar types of events.
Our Caregiver can refuse to provide care if he/she finds the work place unsafe due to covid or any other reasons.
PRIVACY – Universal Health Hub is committed to protecting client confidentiality and client health information including without limitation personal information (name, address, contact details, date of birth, financial information) and health information (medical history and conditions, health insurance) (collectively, “Personal Health Information”) in accordance with all applicable laws. Universal Health Hub shall collect, use, disclose and/or store Personal Health Information for the purpose of providing the services only. Universal Health Hub is equally committed to protecting the privacy and personal information of its staff. Client/SDM is therefore prohibited from contacting Universal Health Hub personnel directly and any and all communication with Universal Health Hub staff must be carried out through the Universal Health Hub office.
GOVERNING LAW – This Service Agreement shall be governed by and construed in accordance with the laws of the province in which the services are rendered and the applicable laws of Canada.
LIABILITY – In no event shall Universal Health Hub and its affiliates, and each of their directors, officers, employees, subcontractors, agents or successors and assigns be held liable for any claims, damages (direct, indirect, consequential or otherwise), losses, liabilities (whether accrued, actual, contingent or otherwise), actions, demands, suits, judgments, causes of action, legal proceedings, penalties or other sanctions and any costs and expenses arising in connection therewith, including, without limitation, legal fees and disbursements on a solicitor and client basis (including, without limitation, all such legal fees and disbursements in connection with any appeals) (collectively, “Claims”) arising from or in connection with any act or omission on the part of, or instructions given by, the Most Responsible Practitioner (MRP), any person acting as an employee or agent of the MRP, applicable health authority, payor, insurance provider or otherwise. The Client/ Payor hereby agrees to indemnify and hold Universal Health Hub harmless from and against any and all Claims. This Service Agreement, where scanned and/or transmitted by electronic transmission, will be deemed an original. No waiver of, failure to exercise, or delay in exercising, any section of this Service Agreement constitutes a waiver of any other section (whether or not similar) nor does any waiver constitute a continuing waiver unless otherwise expressly provided. If any of the provisions of this Service Agreement shall be held by a court or other tribunal of competent jurisdiction to be illegal, invalid, or unenforceable, such provisions shall be limited or eliminated to the minimum extent necessary so that this Service Agreement shall otherwise remain in full force and effect.
By signing this Service Agreement, I, Client/SDM acknowledge, understand and agree to the terms and conditions on the front and back of this Service Agreement
By signing this Service Agreement, I, Payor, acknowledge, understand and agree to the terms and conditions on the front and back of this Service Agreement, as applicable, and to pay invoices issued hereunder upon receipt over email
you will get $50 credit on your first invoice.
PSW Services (Touch):
Performing a bed bath, “assist” with bath or shower, put on and remove clothes (dressing and undressing), preparing and assisting with Sitz bath, assisting with and carrying out changing of personal hygiene products (eg brief), assisting with and carrying out the washing, rinsing and drying of the perineal area, “assisting” to use a toilet, commode, urinal or bedpan, cleaning the skin around an indwelling catheter, emptying of urinary drainage bag and stoma bag, applying a condom catheter, measuring and recording amount of urinary output, attaching, securing and detaching urinary drainage bag, “assist” with and carrying out the washing of hair, assisting with and carrying out the application of medicated shampoos, medicated lotions, creams and ointments to the skin, cleaning of mouth area and dentures, assisting with and carrying out the application of non-prescription skin lotion and powder, brushing or combing the hair, assist with and carrying out the moisturizing of lips, assisting with and carrying out the shaving of facial hair with an electric razor, drying and brushing hair after washing, assisting with and carrying out changing of personal hygiene products (eg brief), filing fingernails and toenails (non diabetic only), assisting with blood glucose testing and recording, assisting with and carrying out the transfer of from one location to another, assisting to turn and reposition; assisting with ambulation, assisting with and carrying out the administration of inhalants to a Patient, assisting with and carrying out the application and removal of prostheses and orthotic devices, assisting with and carrying out the application of dry dressings, transferring using transfer equipment (unless physician prohibited mobility). No use of mechanical lifts, assisting with or carrying out range of motion exercises prescribed by Physiotherapist and/or Occupational Therapist as “part of an activity of daily living”, applying compression stockings, inserting a suppository, if the suppository is part of an activity of daily living, assisting with and carrying out urine testing with test strips or similar technology to determine sugar and acetone levels but excluding the interpretation of results, measuring and recording fluid intake, “assisting” to take oral medication, if the Patient needs physical assistance to take the medication, “assisting” with pre-loaded injections, excluding the administration of the injection itself, assisting with the administration of oxygen, assisting with and carrying out the administration of eye and ear drops,
Home Support Services (Touchless):
cleaning sink, bath and shower after use, emptying commode, urinal or bedpan after assisting with toileting, cleaning toilet, commode, urinal or bedpan after assisting with toileting, washing, drying and putting away dishes used to assist with feeding, cleaning surfaces of counters and appliances used to assist with feeding, cleaning kitchen and bathroom floors with wet mop, as necessary, dusting, mopping and vacuuming primary living area, disposing of garbage, washing laundry in washing machine, drying laundry, assisting with the preparation of a grocery list, shopping for groceries, baby sitting/child care, Banking: mailing cheques, assisting with and carrying out the preparation of meals that take no longer than 30 minutes to prepare, warming prepared food, dividing and storing prepared meals and food, assisting with and carrying out the feeding, assisting with and carrying out the cleaning of client after a meal, planning menus, Medication reminder, Going on walks, Reading out loud, Playing card or board games, General companionship and conversation, Care for pet, Water plants, fold and put away laundry, Ironing laundry, Arrange for public transportation, assist to prepare for a bath or shower, Other Light Housework