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November 21, 2008

Caregiver Support

Elite
Provider

..........................................

It is estimated that U.S. companies lose up to $33 billion annually due to family caregiving duties of their employees.

Elite Home Care Provider Network Sign-Up:

* Provider Name:

* Address:

* City:

* State:

* Zip Code:

* Main Contact:

* Phone #:

* Provider Email:

Non-Profit Org.?:

Non-Profit For Profit

Does the agency have liability insurance coverage?:

Yes No

How much Insurance?

( do not enter commas )

Are all employees of the agency protected by state Worker"s Compensation?:

Yes No

Does the agency use independent contractors?:

Yes No

Are all independent contractors protected by state Worker"s Compensation?:

Yes No

Is the agency bonded?:

Yes No

Types of Services:

Non-Medical Home Health Care
Live-In Companion Care
Physical Therapy

Skilled Nursing Care
Speech Pathology Therapy
Occupational Therapy

Pricing:

Fee: $ per hour/day - Minimum Hours:
Live-In Rate: $
Payment methods:
Private Pay Medicare Medicaid Supplemental Insurance
Carriers:

Specific Companionship and Homemaking Services:

Conversation & Companionship
Recreational Activities
Grooming & Dressing Assistance
Grocery Shopping
Respite Care
Laundry & Linen Washing

Meal Preparation
Light Housekeeping
Shopping & Errand Services
Transportation
Emergency Monitoring

Personal Care Services:

Bathing
Transferring & Positioning
Medication Reminders
Special Diet/Meal Preparation
Toileting

Mobilty
Incontinence Care
Oral Hygiene
Feeding