Common Contracts

AFC – RESIDENT CARE AGREEMENT

Resident Care Agreement • June 28th, 2017

• Contract Type
  Resident Care Agreement
• Filed
  June 28th, 2017

Resident Name: Name of Home: License Number This agreement to provide adult foster care for (resident’s name) is made between (licensee name) and (resident/resident’s designated representative).  This agreement is required to be completed at the time of a resident’s admission, reviewed annually, and updated as needed to reflect changes. This agreement is to be completed by the licensee in cooperation with the resident or his/her designated representative and the responsible agency, if applicable, Designated representative means that person or agency which has been granted written authority, by a resident, to act on behalf of the resident or which is the legal guardian of a resident. Acceptable written authority includes orders of guardianship or conservatorship, powers of attorney, durable powers of attorney, or other documents executed by the resident that specify the relevant scope of authority. If a resident’s designated representative signs this agreement, a copy of the sign