We provide a pro bono greeting of up to 2hrs of valued and billable at and hourly rate of up to 350.00 hour beyond your pro bono time.
We include the following in our Phase 1 Rapport/Discovery
We require an initial retainer deposit of up to 10,000.00 and/or a major credit card to secure advisory services beyond the pro bono period. The remaining balance of the retainer will either be returned if no future services are contracted or rendered or can be applied toward the initial service deposit or services provided.
Fees, Expenses and Invoicing
We will charge you for our services at our customary hourly rates for all distinct services. Other rates may include flat rate services and management services. Our current invoicing rates, practices and terms and conditions are set forth in Enclosure 1 to this agreement. We will itemize and make available to you all related charges. We shall disclose expenses that may be accrued in advance prior to initiating them set for approval or denial.
We reserve the right to ask for additional funds for current or future services that may be called
We may ask for such fees in the form of Wire Transfer and/or Credit Card Preauthorization Holding on the card.
Invoicing for services will occur upon service engagement, retainers, approved expenses, added service security deposits, holding fees and for standard services such as advisory, consulting, management, visits, travel, live in or hourly care. Invoicing is typically on a biweekly basis on a Monday but may occur at anytime.
You agree to pay invoices within 72hrs of receipt by the following approved methods of payment
If you can’t pay within the time frame above then we require a written reason to email@example.com explaining why and when payment will be rendered. We reserve the right to charge at an interest 9% per annum on the balance owed (under New York state civil Practice Law Rules).
We reserve the right to use the “Service Deposit” or “Credit Card” for immediate or future unpaid balances or final services.
Termination of Services and Changes
You may terminate services in a written manner to the address 10 Herrick Drive Old Tappan, New Jersey 07675.
10 Herrick Drive Old Tappan, New Jersey 07675.
Attention: Patient Services
Correspondingly, if for any reason we feel the relationship with you is no longer suitable for either party, we may, upon written notice, terminate service with the contracted party(ies) by giving you
In either event, we will be entitled to full payment for services rendered or owed at that time.
We will cooperate in discharging and transitioning care to your preferred legal caregiver.
If you terminate services, you are responsible for written notice and reason as well as complying with our policies above, termination of services time frames and fees to permit proper patient discharge and transition to the new caregivers. We reserve the right and will charge for the entire unused service period in the event there is a breach to these terms and conditions.
This letter will be effective upon receipt of a signed copy of our formal letter and a specified retainer amount shall be submitted to
Deposit Wire Account: provided
A Major Credit Card shall be held on file for payment security and you authorize a charge in a specified amount with a convenience fee of 3.5%.
Service Security Deposit
Service Security Deposits are held in a non-interest bearing account to secure end of service that may happen suddenly due to permanent hospitalization or death. In certain cases estates freeze all accounts limiting or preventing all medical bills from being paid.
A financial guarantor may be a person outside the estate willing to pay for all medical bills on behalf of the contracted party/patient. We reserve the right to ask for such consent to such a guarantor.
Optional Holding Fees are billable at a 50% of the hourly, weekly or monthly service rates in order to secure that your caregiver or caregiver team, management will remain as yours. This insures that the patient does not lose their dedicated person or team in the event there is a desire or need to suspend service due to travel or temporary hospitalization.
In the event no Holding Fee is requested, no further charges will be accrued, however with respect to our caregivers, their loyalty and need to work, they may take contract with another patient.
This Holding Fee is designed to insure that your team remains your for the entirety of your care need.
Apart from this agreement, a more specific patient service contract may be required that would be inclusive of
Quality Assurance and Disputes
Our Agency-Patient relationship is confidential. We act as the fiduciary to the patient’s well-being and care. We follow lawful homecare and clinical services practices illustrated in the Patient Handbook that discloses patient rights, homecare rights and the rights of our caregivers.
Our primary duty is to do no harm and provide legal and competent service to the patient. We oversee all care to the patient that aims to prevent any foul play or undermining of care to the patient.
We are a service and quality driven organization that can handle disputes reasonably and diplomatically to ensure the outcome we both seek.
We practice full transparency on our care practices and billing practices. If you have any questions, comments or issues, we encourage you to communicate with your Care Manager so we can rectify the issue before it escalates.
We do not anticipate disputes. However, the rules governing disputes or complaints regarding our practices in NYS
As a home care client, you have the right to voice and submit complaints and dissatisfaction about the care and services provided or not provided by:
GLOBAL PRIVATE HOME CARE LIMITED LIABILITY COMPANY
The procedure to submit your complaints are as follows:
The agency will investigate your allegations within 15 days of receipt of complaint. Also, if dissatisfied with the outcome, you may submit and appeal to the agency’s governing authority. All appeals will be reviewed within 30 days of receipt of appeal request.
In New York State, home care clients may also submit complaints to the Department of Health. If you are dissatisfied with the outcome of our complaint resolution, you may also submit the complaint to the New York State Department of Health or any outside representative of the client’s choice.
NYS Department of Health
Metropolitan Regional Office
90 Church Street
New York, NY 10007
The expression of such complaints by the client or client designee shall be free from interference, coercion, discrimination, or reprisal.
If a dispute arises between the agency and the contracted parties regarding our fees, expenses, services or any matter between us, you agree that the prevailing party is responsible for all reasonable expenses and legal costs.
Patient Medical Records and Clinical Notes
You agree to sign a HIPAA agreement to release medical records pertaining to the patient’s care, permit a physician order for care and to not tamper, alter or prevent VIPrivate Care from its clinical records.
Clinical notes/records must be stored and kept from any person other than the contracted caregivers themselves or its management.
We require immediate return of all Clinical Notes/records for legal purposes.
HIPAA, Patient and Home Care Rights
Please see the NYS Patient Handbook
The Agreement shall be governed by, construed in accordance with, The Laws of the State of New York notwithstanding any conflict-of-laws doctrine to the contrary. This agreement may be executed and delivered by fax to 646-219-4593 and/or scanned and emailed to firstname.lastname@example.org or mailed to 10 Herrick Drive Old Tappan, NJ 07675 and will be binding whether executed manual in the original or by other means and may be legally executed by a DPOA, POA or Spouse or legal party related to the patient.
This agreement represents legal Home Care and Concierge Nursing services to the party.
In terms set forth in any Agreement are satisfactory, please sign and date a copy of the agreement and return by the means sated above.
Should you have any questions or changes to this agreement, please call 866.863.6800 and speak to Patient Services to avoid any misunderstanding or misinterpretation concerning this engagement.