We the undersigned confirmed that we accept the home-care service as defined in the attached clinician treatment plan document
We hereby agree following service aspects: Clinician treatment plan:
I understand that the Clinician assigned to my care is responsible solely for the care of the patient. Any non-patient care related work like personal work of other family members, kitchen work and washing utensils, etc., all of which constitute non-medical non-patient work, will not be given to the clinicians. I will do the advance payment for the service. Also, if clinician is not treated considerately and payment is not done on time, the service will be immediately withdrawn.
I (PATIENT KIN / PATIENT) ------------------- would like to confirm that I have read and understood the above conditions to be adhered in employment of Portea Medical staff. I will bear responsibility and ensure that these conditions are fulfilled to the best of my abilities.
Name & Signature
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