Submit Your ENQUIRY

Submit Your ENQUIRY

Submit Your ENQUIRY

Submit Your ENQUIRY

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:

  • Clinician treatment plan:
  • Service timings:
  • Price:
  • Clinician arrangements:
  • Stay / toilet facilities:
  • Stay at home :
  • Proper Bedding :
  • Toilet. At home :
  • Meal Arrangements:
You have to provide food allowance or meals to the clinicians

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 Also, if clinician is not treated considerately and payment is not done on time, the service will be immediately withdrawn.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.

Date:

Location:

Patient Id:

Name & Signature


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