[{"id":"348354c9-d184-4d01-8c6e-05232c1cd9fc","order":1,"text":"PERSONAL CARE AGREEMENT","fontSize":"20","textAlign":"center","bold":true,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"e263990d-e558-4e4d-915e-90d956a487d5","order":2,"text":"(Caregiver Contract — Personal Services Contract)","fontSize":"14","textAlign":"center","bold":false,"underline":false,"marginBottom":"26","cflou":false,"active":true},{"id":"ac820f70-7342-449f-945a-04e6e23a663d","order":3,"text":"THIS PERSONAL CARE AGREEMENT (this \"Agreement\") is made and entered into as of [Effective date] (the \"Effective Date\"), by and between the following parties:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"14","cflou":false,"active":true},{"id":"d23ae1f7-7b9c-4df6-8c99-4184add10128","order":4,"text":"[Full legal name of the Care Recipient], born on [Date of birth], residing at [Street address], [City], Ohio [ZIP code] (the \"Care Recipient\");","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"72e70861-d63d-49f5-a042-468840d4f708","order":5,"text":"and","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"32b57d6e-17f0-46d2-a348-fc69db4dff78","order":6,"text":"[Full legal name of the Caregiver], the Care Recipient's daughter, residing at [Street address], [City, State and ZIP code] (the \"Caregiver\").","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"12","cflou":false,"active":true},{"id":"397283c7-3485-4836-9d62-d6b4b70c2be9","order":7,"text":"The Care Recipient and the Caregiver are referred to individually as a \"Party\" and collectively as the \"Parties\".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"12","cflou":false,"active":true},{"id":"c0bcf510-a643-459d-9acc-d8af746fb80c","order":8,"text":"The Care Recipient acts in this Agreement by and through [Full legal name of the agent], attorney-in-fact under the durable power of attorney executed by the Care Recipient on [Date of the power of attorney], which confers upon the agent authority to contract for personal, family and household services on the Care Recipient's behalf. The agent represents that entering into this Agreement is consistent with the Care Recipient's known wishes and best interests and that, where the agent is also the Caregiver, the safeguards described in the Article entitled \"Prohibited Transactions and Conflicts of Interest\" have been observed.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"12","cflou":false,"active":true,"displayConditions":[{"field":"536ca3c1-858a-4e1b-9c71-19eb1207d61e","value":"by agent","type":"add","operator":"="}]},{"id":"1744f2bc-ca3f-40bc-88e6-a690d380d779","order":9,"text":"RECITALS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"16"},{"id":"c4886fbe-060b-4112-ae0a-79c3d888f80b","order":10,"text":"WHEREAS, the Care Recipient requires ongoing assistance with the activities of daily living and the instrumental activities of daily living by reason of [Conditions and limitations of the Care Recipient], and wishes to receive that assistance in a home setting for as long as it is safe and practicable to do so;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"8a2677fd-74f2-4ad3-a214-d87c0732f710","order":11,"text":"WHEREAS, the Caregiver is willing and able to render the services described in this Agreement and has the skill, the time and the availability necessary to do so;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"caefb260-bd75-4a80-a079-9a9f9dce3bdf","order":12,"text":"WHEREAS, the Parties intend that the Caregiver be compensated at fair market value for services actually rendered on and after the Effective Date, and that no part of the compensation payable under this Agreement constitute a gift, a bequest, a transfer for less than fair market value or an uncompensated transfer within the meaning of 42 U.S.C. § 1396p(c) and of the corresponding rules of the State Medicaid Agency;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"6aef1d75-6702-42aa-b1ab-d5f663cd87a0","order":13,"text":"WHEREAS, the Parties acknowledge that assistance rendered by a family member in the absence of a written agreement is presumed in most states to have been rendered gratuitously, and that no compensation whatever is payable under this Agreement for any service rendered before the Effective Date;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ece7bc21-cdc3-4eb5-94f8-4afdd4ba6532","order":14,"text":"WHEREAS, the Care Recipient has the capacity to understand and to enter into this Agreement and does so freely and voluntarily, without duress, undue influence or misrepresentation;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"536ca3c1-858a-4e1b-9c71-19eb1207d61e","value":"personally","type":"add","operator":"="}]},{"id":"3e572403-7a1a-46a8-b3be-9ed7384e98d2","order":15,"text":"WHEREAS, this Agreement is entered into on the Care Recipient's behalf by the Care Recipient's duly appointed agent, acting within the scope of the authority conferred by the durable power of attorney and in what the agent believes to be the Care Recipient's best interests;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"536ca3c1-858a-4e1b-9c71-19eb1207d61e","value":"by agent","type":"add","operator":"="}]},{"id":"e800861e-84fc-4ed2-b7cc-a83bd83a2141","order":16,"text":"NOW, THEREFORE, in consideration of the mutual promises and covenants set out below, and for other good and valuable consideration the receipt and sufficiency of which are acknowledged, the Parties agree as follows:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"226ce1a3-3954-4b31-8b29-dd1a587fd595","order":17,"text":"1. DEFINITIONS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S01"},{"id":"240b1141-711e-4236-b369-0351a0600cdd","order":18,"text":"\"Activities of Daily Living\" or \"ADLs\" means bathing, dressing, grooming, oral care, toileting and continence care, transferring, ambulation, positioning and eating.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"98217d49-39b5-4180-a392-3270295431c0","order":19,"text":"\"Business Day\" means any day other than a Saturday, a Sunday or a day on which the banks of the jurisdiction whose law governs this Agreement are authorized or required to close.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"cee24be4-8e95-4e57-a933-09e768b94b98","order":20,"text":"\"Care Log\" means the contemporaneous written record of services described in the Article entitled \"Care Log, Invoices and Records\".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"6c8e5674-df4f-4a60-bc6c-57b75ac04a8f","order":21,"text":"\"Designated Family Contact\" means [Name and telephone number], or any other person whom the Care Recipient afterwards notifies in writing to the Caregiver.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"39a42fa4-07ff-4e2e-b1d7-0b5b2fa84693","order":22,"text":"\"Fair Market Value\" means the amount that would be charged, in the locality in which the Services are rendered, by a licensed home care agency or by an unrelated private caregiver for services of the same nature, frequency and intensity.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"7924f421-00a5-4469-af44-74607c8cac25","order":23,"text":"\"Instrumental Activities of Daily Living\" or \"IADLs\" means meal planning and preparation, light housekeeping, laundry, shopping and errands, medication reminders, use of the telephone and other means of communication, the making and keeping of appointments, and assistance with correspondence and household paperwork.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"8e38bf49-b372-4569-9319-cfd3177fca71","order":24,"text":"\"Look-Back Period\" means the period preceding an application for Medicaid long-term care benefits during which transfers of assets are reviewed by the State Medicaid Agency. That period is presently sixty (60) months for transfers made on or after 8 February 2006 under 42 U.S.C. § 1396p(c)(1)(B), subject to any shorter period that a state applies to home and community based services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"0f008034-0fa5-4ade-99ac-e9e369d86080","order":25,"text":"\"Medicaid\" means the medical assistance program established under Title XIX of the Social Security Act and administered by the State Medicaid Agency.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"08909942-0273-47f3-99c7-6008e332e2a9","order":26,"text":"\"Plan of Care\" means the written description of the assistance required by the Care Recipient referred to in the Article entitled \"Plan of Care and Review of Needs\".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"3651cbe7-aaee-4c49-87a4-114ec81fd08f","order":27,"text":"\"Residence\" means the dwelling in which the Services are principally rendered, as identified in the Article entitled \"Place of Performance\".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"68daf221-a9b7-4771-8ba2-9b74aed92c8f","order":28,"text":"\"Services\" means the services described in the Article entitled \"Services to be Provided\", together with any additional service agreed in writing by the Parties.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"a2da7c29-c99b-4148-bf44-950cb927f9c4","order":29,"text":"\"State Medicaid Agency\" means the single state agency administering Medicaid in Ohio, and any successor agency.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ced996a6-6fd4-49b2-8067-6e93fc3d185e","order":30,"text":"2. ENGAGEMENT OF THE CAREGIVER AND PURPOSE OF THIS AGREEMENT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S02"},{"id":"fc869700-7339-44fe-93af-cf2739517493","order":31,"text":"The Care Recipient engages the Caregiver, and the Caregiver accepts the engagement, to render the Services upon the terms set out in this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"a07a6233-520e-42eb-8e47-ad66edd6798d","order":32,"text":"The purpose of this Agreement is to record, in advance and in writing, the terms upon which the Caregiver is to be paid Fair Market Value for services actually rendered. The Parties intend this Agreement to be a bona fide contract for personal services supported by adequate consideration, and not a device for the transfer of assets.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1d63f3f8-5d6c-49f1-802d-7b620036e847","order":33,"text":"The Parties further intend that every payment made under this Agreement be treated as a transfer for fair market value and therefore be excluded from the computation of any period of ineligibility under 42 U.S.C. § 1396p(c)(1) and, to the extent applicable, that the transfers effected by this Agreement be treated as made exclusively for a purpose other than to qualify for medical assistance within the meaning of 42 U.S.C. § 1396p(c)(2)(C).","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"303fcf2c-db1e-4394-a913-3ba578ea8fb5","order":34,"text":"3. TERM AND ABSENCE OF COMPENSATION FOR PRIOR SERVICES","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S03"},{"id":"e23cf00d-551d-41d4-afc6-d4eeaf2dc100","order":35,"text":"This Agreement takes effect on [Effective date] and continues from month to month until it is terminated in accordance with the Article entitled \"Termination\".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"7e54c1d0-8ff7-4d2e-b1b9-23c63bf1c030","order":36,"text":"No compensation is payable under this Agreement for any service rendered before the Effective Date. The Parties acknowledge that any assistance previously furnished by the Caregiver was furnished gratuitously, and the Caregiver releases and waives any claim to payment for it.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"2c008ba9-90c5-473f-ae7c-ea171e456d02","order":37,"text":"This Agreement is not a lifetime care contract. Neither Party has prepaid, and neither Party shall prepay, any amount in respect of services not yet rendered. Compensation is earned only as the Services are rendered.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"12f34d47-f4f2-4521-9d8a-09d38e180306","order":38,"text":"4. PLACE OF PERFORMANCE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S04"},{"id":"0fb2198b-3a46-48e6-acb1-8702ee06da78","order":39,"text":"The Services shall be rendered at the Care Recipient's residence, the Caregiver maintaining a separate household, and at such other places as are reasonably incidental to the Services, including medical offices, pharmacies, places of worship and places of recreation.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"f4fc1b2a-21d4-45e6-97cc-8a0f27a2e8d5","order":40,"text":"The Residence for the purposes of this Agreement is [Street address], [City], Ohio.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Caregiver's residence, in which the Care Recipient resides","type":"remove","operator":"="}]},{"id":"12c70e8a-6a01-44da-8678-f48cac57c36a","order":41,"text":"The Residence for the purposes of this Agreement is the Caregiver's dwelling at [Street address], [City, State and ZIP code].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Caregiver's residence, in which the Care Recipient resides","type":"add","operator":"="}]},{"id":"cbea02be-90bb-4cff-b6a8-87a5358180f1","order":42,"text":"A change of Residence requires the written agreement of both Parties and shall be recorded by a written amendment to this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"7442840d-1ad8-4cfc-ac35-5c1f4c5199ff","order":43,"text":"5. SERVICES TO BE PROVIDED","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S05"},{"id":"bffc3f68-6229-4e8e-b12a-64f8b2bf6246","order":44,"text":"The Caregiver shall render the following Services to the Care Recipient: personal care consisting of assistance with the ADLs; homemaking and household support consisting of assistance with the IADLs; companionship, supervision and safety monitoring; accompaniment to medical, dental and therapy appointments; communication with the Care Recipient's physicians, pharmacists and other providers to the extent authorized by the Care Recipient; the monitoring and reporting of any change in the Care Recipient's condition; and assistance in coordinating any other service or benefit to which the Care Recipient is entitled.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ca8999cc-1e6d-48d5-bf5d-2b30a71780cd","order":45,"text":"The Parties have further agreed that the Caregiver shall render the following additional services: [Additional services agreed by the Parties], which form part of the Services for all purposes of this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"32b7141e-c425-47df-9ccf-b4bd75c45e4b","order":46,"text":"The Caregiver shall not perform any act constituting the practice of nursing, medicine, pharmacy or physical therapy unless the Caregiver holds a current license authorizing that act under the law of Ohio. The Caregiver may remind the Care Recipient to take medication, may read a label aloud and may open a container at the Care Recipient's request, but shall not administer medication except so far as applicable law permits.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"8d70b55d-4d34-4b45-a584-d54c82ed92dd","order":47,"text":"The Services do not include the advance of funds by the Caregiver, the payment of the Care Recipient's household expenses out of the Caregiver's own resources, or the management of the Care Recipient's financial affairs, none of which is undertaken under this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"8d2a4c3d-e0d9-4f20-9672-acb514c7599d","order":48,"text":"6. PLAN OF CARE AND REVIEW OF NEEDS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S06"},{"id":"05080b55-9352-4cc8-b823-264db5ce1438","order":49,"text":"The Services shall be rendered in accordance with a written Plan of Care describing the assistance the Care Recipient requires, its frequency and any precaution to be observed. The Plan of Care shall be prepared or approved by the Care Recipient's physician, by a registered nurse, or by a licensed social worker or geriatric care manager, and a copy of it shall be retained with this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4939d31c-c1c3-40d6-aa92-17a9d31e16ea","order":50,"text":"The Care Recipient shall obtain and retain with this Agreement a written statement from the Care Recipient's physician or from another qualified clinician confirming that the Care Recipient requires the assistance described in this Agreement. Several states require such a statement before payments made to a family caregiver will be recognized as made for fair market value.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"9f927007-0cf1-4505-b83d-12daddaffc93","order":51,"text":"The Care Recipient's needs shall be reviewed at least once in every twelve (12) months, and upon any material change in the Care Recipient's condition. A review may lead to a written amendment adjusting the Services, the schedule or the compensation, in each case prospectively only.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"a9fc07e7-78f7-4e7a-bc77-2a1c883ee641","order":52,"text":"Where a review shows that the Care Recipient's needs exceed what the Caregiver can safely and lawfully provide, the Parties shall consider engaging additional professional services or a change of care setting, and neither Party shall treat the raising of that question as a breach of this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"7ab639ff-478c-4282-925f-4d64fdfd3d6f","order":53,"text":"7. SCHEDULE OF CARE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S07"},{"id":"f1a478be-54ec-4681-86ce-8038a815b388","order":54,"text":"The Caregiver shall render the Services for approximately [Hours per week] hours per week. The usual days and hours of care are [Days and hours of care], subject to the adjustments provided for below.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"b28bf475-0f57-405a-8de6-58dc90346a1f","order":55,"text":"The schedule is a good faith estimate. The hours actually worked in any period shall be recorded in the Care Log and shall govern the compensation payable wherever compensation is calculated by reference to hours worked.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"c4ad77b8-3829-4279-85db-60c0bf81a258","order":56,"text":"Either Party may propose a change to the schedule. A change that materially increases or reduces the weekly hours shall be recorded in a written amendment signed by both Parties before it takes effect.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ee321244-570a-4f57-b11e-6686d6bb7a49","order":57,"text":"The Caregiver is not required to be available twenty-four (24) hours a day. Neither the presence of the Caregiver in the Residence outside the scheduled hours nor an occasional response to an emergency shall be treated as an extension of the schedule or as creating an entitlement to additional compensation, unless the Parties agree otherwise in writing.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"85c255fc-f0b9-471d-a95e-47985995b2ee","order":58,"text":"8. COMPENSATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S08"},{"id":"1ff3a58c-422c-4559-9a05-456e6cb290ab","order":59,"text":"In consideration of the Services, the Care Recipient shall pay the Caregiver on the basis of an hourly rate, calculated as set out below.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"a49a3b91-fca1-4131-bdf3-ed34b81e3d72","order":60,"text":"The Care Recipient shall pay the Caregiver [Hourly rate] U.S. dollars for each hour of Services actually rendered and recorded in the Care Log.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b450b87d-0daa-4a99-8bb6-8dd27d486622","value":"an hourly rate","type":"add","operator":"="}]},{"id":"e4e76c19-831f-4de0-98fb-102e6a2efb34","order":61,"text":"The Care Recipient shall pay the Caregiver [Weekly amount] U.S. dollars for each full week during which the Services are rendered in substantial accordance with the schedule. Where the Services are rendered for part of a week only, the amount payable shall be prorated by reference to the hours recorded in the Care Log.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b450b87d-0daa-4a99-8bb6-8dd27d486622","value":"a fixed weekly amount","type":"add","operator":"="}]},{"id":"1008235c-4f3a-4968-93dc-58a1df98d403","order":62,"text":"The Care Recipient shall pay the Caregiver [Monthly amount] U.S. dollars for each full calendar month during which the Services are rendered in substantial accordance with the schedule. Where the Services are rendered for part of a month only, the amount payable shall be prorated by reference to the hours recorded in the Care Log.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b450b87d-0daa-4a99-8bb6-8dd27d486622","value":"a fixed monthly amount","type":"add","operator":"="}]},{"id":"bb71588d-dc95-44da-b31d-3c8dab104f37","order":63,"text":"Compensation is payable every two weeks, in arrears, and only after the Services to which it relates have been rendered. Payment shall be made by check or electronic funds transfer, drawn on or transferred from an account in the name of the Care Recipient to an account in the name of the Caregiver. Payment in cash is prohibited.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"456c3518-f3c7-4833-b5de-346a44c9c1b6","order":64,"text":"No compensation accrues for any day on which the Care Recipient is hospitalized, is resident in a rehabilitation, assisted living or nursing facility, or is otherwise absent from the Residence, unless the Caregiver in fact renders Services on that day and records them in the Care Log.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"98ec6f4a-cdca-40a6-8b73-354afdc13fe7","order":65,"text":"The compensation payable under this Agreement is the whole of the consideration payable to the Caregiver. The Caregiver is not entitled by reason of this Agreement to any bonus, severance payment, retirement benefit, paid leave, share of the Care Recipient's estate or other benefit.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"030b0aa5-1143-44ba-b2f7-443cee29c6e5","order":66,"text":"The rate of compensation may be reviewed once in each calendar year and may be adjusted by a written amendment signed by both Parties, provided that the adjusted rate does not exceed Fair Market Value and that the adjustment operates prospectively only.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"6b02fa04-ddd0-4ebe-b148-57737d9b54ef","order":67,"text":"Any amount that is due and remains unpaid bears simple interest from its due date until payment at the rate allowed by the law of Ohio upon a money judgment or, where that law fixes no such rate, at six percent (6%) per annum. The Caregiver shall not suspend the Services on account of a payment dispute where the suspension would place the Care Recipient at risk, but may terminate this Agreement as provided in the Article entitled \"Termination\".","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1a2a6599-9646-4b51-85eb-a2edc2a94ce7","order":68,"text":"9. WAGE AND HOUR COMPLIANCE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}],"sectionNum":"S09"},{"id":"3c48710f-e466-40c4-8eb2-76ba0cf13d7f","order":69,"text":"The Parties intend that the compensation payable under this Agreement comply with the Fair Labor Standards Act, 29 U.S.C. § 201 and following, and with the wage and hour law of Ohio and of the locality in which the Services are rendered. The Caregiver shall in every case receive not less than the highest applicable federal, state or local minimum wage for each hour worked.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"947abe9e-f790-4650-a713-5cff441b3692","order":70,"text":"The workweek for the purposes of this Agreement is a fixed and regularly recurring period of seven (7) consecutive twenty-four (24) hour periods beginning at 12:01 a.m. on Sunday. Where the Caregiver works more than forty (40) hours in a workweek and no exemption applies, the Care Recipient shall pay the Caregiver one and one-half times the Caregiver's regular rate of pay for each hour worked in excess of forty (40).","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"983a7fd9-0cc0-438d-be0b-53ac52a647e1","order":71,"text":"Where the law of Ohio or of the locality requires a higher minimum wage, overtime upon a different basis, a weekly day of rest, a spread-of-hours or split-shift payment, paid sick leave, a written notice of pay rate or any other protection more favorable to the Caregiver, that law prevails over this Article and the Care Recipient shall comply with it.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"3cbd5880-97bd-4f83-931e-5eb2f676e105","order":72,"text":"The Parties acknowledge that an individual, family or household employer may claim the exemption for companionship services conferred by 29 U.S.C. § 213(a)(15), and that a domestic service employee who resides in the household is exempt from the overtime requirement, but not from the minimum wage requirement, under 29 U.S.C. § 213(b)(21), in each case only where the conditions of those exemptions and of the regulations at 29 C.F.R. Part 552 are satisfied. The scope of the companionship services exemption is narrow, is presently the subject of federal rulemaking, and is unlikely to be available where the Caregiver spends more than an incidental proportion of the working time assisting with the ADLs. Neither Party relies upon the other's assessment of whether an exemption applies.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"1160f41e-379b-4d5e-a543-114b888ec129","order":73,"text":"The Care Recipient shall keep, for not less than three (3) years, the records of the hours worked and of the wages paid that are required by 29 C.F.R. Part 516. The Care Log and the invoices are intended to satisfy that requirement, and the Caregiver shall complete them accurately and without delay.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"d754f483-3331-4abd-bec0-abf500c819ad","order":74,"text":"The Care Recipient shall not retaliate against the Caregiver, and shall not terminate this Agreement, because the Caregiver has asserted a right under any wage and hour law or has cooperated with an inquiry by a labor authority.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"4c3cb4f3-7b79-419f-a4f8-86b10fa4f969","order":75,"text":"10. FAIR MARKET VALUE AND ABSENCE OF ANY GIFT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S10"},{"id":"cd6a6d50-87e2-4fe4-9023-f0d8c9d57fd5","order":76,"text":"The Parties have determined the compensation payable under this Agreement by reference to written quotations obtained from licensed home care agencies serving the Care Recipient's locality, and each Party represents that the compensation does not exceed the Fair Market Value of the Services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"0fd91645-053a-4f7f-92af-b99c7a7054ff","order":77,"text":"The Care Recipient shall retain the evidence of that determination together with a copy of this Agreement, the Care Log, the invoices and the records of payment, and shall produce them to the State Medicaid Agency, to the Internal Revenue Service or to any other authority upon request.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"b4a41dbe-323b-44d7-8b96-3bb2563b6e55","order":78,"text":"The Parties expressly disclaim any donative intent. No payment made under this Agreement is intended as a gift, as an advance upon an inheritance or as a transfer for less than fair market value, and each payment is made in exchange for services of at least equal value actually rendered.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"8b715f15-6f6c-4f00-9b9d-5024eabeb878","order":79,"text":"The Parties acknowledge that the State Medicaid Agency reviews transfers of assets made during the Look-Back Period, that a transfer for less than fair market value may result in a period of ineligibility for long-term care benefits, and that this Agreement is intended to establish that the payments made under it are made for fair market value.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"13e7c675-f165-4e32-b124-39777fdcacd5","order":80,"text":"11. CARE LOG, INVOICES AND RECORDS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S11"},{"id":"2846a679-ba15-43c9-8288-d0278c4cc96c","order":81,"text":"The Caregiver shall keep a contemporaneous written Care Log recording, for each day on which Services are rendered, the date, the time at which the Services began and ended, the total hours worked, a description of the Services rendered, and any incident or change in the Care Recipient's condition. Each entry shall be signed or initialed by the Caregiver. The form set out in Schedule A may be used for this purpose.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"5cc5313b-a2ab-4c48-9a72-b640dd97257e","order":82,"text":"The Caregiver shall deliver to the Care Recipient, for each payment period, an invoice stating the hours worked, the Services rendered, the amount claimed and the manner in which it has been calculated. The Care Recipient may withhold payment of any amount that is not supported by the Care Log until the discrepancy has been resolved.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"826fdd15-ba0f-4a9d-a3c9-e8b53b459e12","order":83,"text":"Each Party shall retain the Care Log, the invoices, the records of payment and all related documents for not less than six (6) years after the termination of this Agreement, and in any event for so long as they may be relevant to an application for Medicaid or to a review of transfers made during the Look-Back Period.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"dc5b6e89-2aa3-4264-bc71-696450dfeb32","order":84,"text":"Every payment shall be traceable. The Care Recipient shall retain cancelled checks, bank statements or electronic transfer confirmations evidencing each payment made under this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"05427c5e-7447-4e1c-9c97-71cf31a6aa38","order":85,"text":"12. EXPENSES AND REIMBURSEMENT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S12"},{"id":"23830cd0-3096-4ccd-be89-47ce093f724a","order":86,"text":"The Care Recipient shall reimburse the Caregiver for out-of-pocket expenses reasonably incurred in rendering the Services, including groceries, household supplies, prescriptions and co-payments purchased on the Care Recipient's behalf, provided that the expense has been approved in advance and is supported by a receipt.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"3fbf9c7c-a690-4258-802c-457cfd3ba2ee","order":87,"text":"The reimbursement of an expense is not compensation, is not consideration for the Services, and shall be recorded separately from the compensation in the invoices and in the records of payment.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"03e1098e-f29f-46f6-ad54-94b8ee917f47","order":88,"text":"The Caregiver shall not incur any single expense exceeding a reasonable household amount, and shall not pledge the Care Recipient's credit, without the prior written approval of the Care Recipient.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"50329cb9-cdb2-439b-8750-95e29b945a26","order":89,"text":"13. TAXES AND EMPLOYMENT STATUS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S13"},{"id":"2a8fd9f6-1ff7-467c-8907-df1af08c235c","order":90,"text":"The Caregiver is engaged as a household employee of the Care Recipient.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"007062f6-a424-46e4-808f-aafff8621e42","order":91,"text":"The Care Recipient shall discharge the obligations of a household employer, including obtaining an employer identification number; withholding and paying the employee and employer shares of Social Security and Medicare taxes where the cash wages paid in the calendar year reach the domestic employment threshold published by the Internal Revenue Service for that year; paying federal unemployment tax where the applicable quarterly threshold is reached; reporting the wages on Schedule H of the Care Recipient's federal income tax return; furnishing the Caregiver with a Form W-2; and complying with the registration, withholding and reporting requirements of Ohio.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"88919e45-7cf7-477d-b74f-48522a1b6823","order":92,"text":"The Parties acknowledge that the exemption from Social Security and Medicare taxes conferred by 26 U.S.C. § 3121(b)(3)(A) in respect of domestic service performed by a child in the employ of a parent applies only where that child is under the age of eighteen (18), and that it accordingly does not apply to an adult child rendering the Services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as a household employee of the Care Recipient","type":"add","operator":"="}]},{"id":"f5b317af-cffe-4bcf-95b7-684346c578e8","order":93,"text":"The Caregiver therefore acts on the Caregiver's own account and is not an employee, a partner, a joint venturer or an agent of the Care Recipient. The Caregiver is responsible for the payment of all federal, state and local income taxes and of self-employment tax arising out of the compensation, shall furnish the Care Recipient with a completed Form W-9, and shall indemnify the Care Recipient against any tax, interest or penalty assessed by reason of the Caregiver's failure to do so.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as an independent contractor","type":"add","operator":"="}]},{"id":"039a077a-b4d5-4253-bcbf-55c14988979f","order":94,"text":"The Parties acknowledge that the characterization of the relationship is determined by the Internal Revenue Service and by the taxing authorities of Ohio according to the degree of control exercised over the manner in which the Services are performed, that the characterization adopted in this Agreement is not binding upon those authorities, and that each Party has been advised to obtain independent tax advice.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as an independent contractor","type":"add","operator":"="}]},{"id":"07739e60-d63e-4a98-8d21-9ae83b1acc8b","order":95,"text":"Where the arrangement is subsequently reclassified as employment by the Internal Revenue Service, by a state agency, by a labor authority or by a court, the obligations of a household employer, including the minimum wage, overtime, withholding, reporting and insurance obligations, may apply retroactively together with interest and penalties. Each Party has weighed that risk before adopting the characterization set out above, and the Care Recipient shall bear the cost of any such reassessment except so far as it results from the Caregiver's own default.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as an independent contractor","type":"add","operator":"="}]},{"id":"7c100bc7-608f-4e64-8d5e-a46f90c04603","order":96,"text":"Compensation paid under this Agreement is taxable income of the Caregiver, who shall report it as required by law. The Parties acknowledge that a failure to report the compensation may cause the State Medicaid Agency to treat the payments as gifts rather than as payments for services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"df2f4662-fed7-4f64-864f-d49d44fe1a54","order":97,"text":"14. ROOM, BOARD AND LODGING","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Care Recipient's residence, in which the Caregiver also resides","type":"add","operator":"="},{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Caregiver's residence, in which the Care Recipient resides","type":"add","operator":"="}],"sectionNum":"S14"},{"id":"c27ba87c-1430-41be-930a-b48dcf31be65","order":98,"text":"The Care Recipient furnishes lodging and meals to the Caregiver in the Residence. The Parties agree that the fair market rental value of that lodging and of the meals furnished is [Monthly value of lodging and meals] U.S. dollars per month, that this value forms part of the consideration received by the Caregiver for the Services, and that the cash compensation otherwise payable shall be reduced by that amount so that the total consideration received by the Caregiver does not exceed Fair Market Value. Where the Caregiver is engaged as a household employee, that reduction shall not exceed the credit for board and lodging permitted by 29 U.S.C. § 203(m) and by the regulations at 29 C.F.R. Part 531, and shall not reduce the cash wages below the applicable minimum wage.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Care Recipient's residence, in which the Caregiver also resides","type":"add","operator":"="}]},{"id":"9e1d2744-096c-461b-9e94-b09ff9b00fee","order":99,"text":"The Caregiver occupies the Residence as a licensee and not as a tenant. No lease, tenancy, life estate or other interest in the Residence is created by this Agreement. Upon the termination of this Agreement for any reason the Caregiver shall vacate the Residence within [Number of days] days.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Care Recipient's residence, in which the Caregiver also resides","type":"add","operator":"="}]},{"id":"cbeb788d-d5f7-4892-9027-09e18aae8809","order":100,"text":"Where the Caregiver is engaged as a household employee, the Parties agree, for the purposes of 29 C.F.R. § 785.23, that the Caregiver resides on the premises, that the hours actually worked shall be recorded in the Care Log, and that bona fide meal periods and a regularly scheduled sleeping period of not more than eight (8) hours are not hours worked, provided that the Caregiver is furnished private quarters and adequate sleeping facilities and can usually enjoy an uninterrupted night's sleep. Any interruption of the sleeping period in order to render Services shall be recorded in the Care Log and paid.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Care Recipient's residence, in which the Caregiver also resides","type":"add","operator":"="}]},{"id":"15f1c2d9-13af-4123-bf7e-5a827bbf7479","order":101,"text":"The Caregiver shall not permit any other person to reside in the Residence, shall not keep any animal there, and shall not receive overnight guests, without the prior written consent of the Care Recipient.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Care Recipient's residence, in which the Caregiver also resides","type":"add","operator":"="}]},{"id":"00015bf7-c8e2-4f51-bceb-5a1ec042b73c","order":102,"text":"The Caregiver shall bear the cost of the Caregiver's own telephone, personal property insurance and personal expenses, and shall make no alteration to the Residence without the prior written consent of the Care Recipient.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Care Recipient's residence, in which the Caregiver also resides","type":"add","operator":"="}]},{"id":"c3b582c4-cd45-40bf-b217-c5f223671798","order":103,"text":"The Care Recipient resides in the Caregiver's dwelling. The Care Recipient shall pay the Caregiver [Monthly amount for room and board] U.S. dollars per month for lodging, utilities and meals. That amount is separate from, and in addition to, the compensation payable for the Services, and represents the fair market value of the lodging and meals furnished.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Caregiver's residence, in which the Care Recipient resides","type":"add","operator":"="}]},{"id":"d95bf6e2-9922-4448-9d61-c26a5e751887","order":104,"text":"The Care Recipient occupies the Caregiver's dwelling as a licensee. No lease, tenancy or other interest in that dwelling is created by this Agreement. Each Party shall give the other not less than the notice specified in the Article entitled \"Termination\" before requiring or effecting a change of residence, except where the health or the safety of either Party requires an immediate change.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Caregiver's residence, in which the Care Recipient resides","type":"add","operator":"="}]},{"id":"e396d367-a2c9-4f00-a53e-264b91e6d3ac","order":105,"text":"Neither the furnishing of lodging nor the payment made for it shall be construed as a gift by either Party to the other, and each shall be recorded in the invoices and in the records of payment.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Care Recipient's residence, in which the Caregiver also resides","type":"add","operator":"="},{"field":"f9f15d37-ce9c-4a84-b2c4-94259227601b","value":"at the Caregiver's residence, in which the Care Recipient resides","type":"add","operator":"="}]},{"id":"88c35a8a-7374-4639-b92d-04676cd9a08f","order":106,"text":"15. TRANSPORTATION AND USE OF A MOTOR VEHICLE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","displayConditions":[{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Caregiver's vehicle","type":"add","operator":"="},{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Care Recipient's vehicle","type":"add","operator":"="}],"sectionNum":"S15"},{"id":"dc703f99-4239-46c5-b592-ce08a887816b","order":107,"text":"The Services include transporting the Care Recipient to medical appointments, to places of worship, to shops and to such other places as the Care Recipient reasonably requires.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Caregiver's vehicle","type":"add","operator":"="},{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Care Recipient's vehicle","type":"add","operator":"="}]},{"id":"882062b7-30c4-49bf-a7b3-3492470c436e","order":108,"text":"Transportation shall be provided in the Caregiver's own motor vehicle. The Caregiver shall hold a valid driver's license and shall maintain automobile liability insurance in at least the minimum amounts required under the law of Ohio, and shall produce evidence of that insurance to the Care Recipient upon request.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Caregiver's vehicle","type":"add","operator":"="}]},{"id":"3c638fd7-b5f7-44e6-8909-1eeba8d04c2c","order":109,"text":"The Care Recipient shall reimburse the Caregiver at the rate of [Rate per mile] for each mile driven in rendering the Services, upon production of a mileage record forming part of the Care Log. Mileage reimbursement is an expense and is not compensation for the Services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Caregiver's vehicle","type":"add","operator":"="}]},{"id":"3537ed62-facc-4ab8-b614-c1886ea6762d","order":110,"text":"Transportation shall be provided in a motor vehicle owned by the Care Recipient. The Care Recipient shall maintain automobile liability insurance covering the Caregiver's operation of that vehicle and shall bear the cost of its registration, insurance, fuel and maintenance. The Caregiver shall hold a valid driver's license and shall operate the vehicle only for purposes connected with the Services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Care Recipient's vehicle","type":"add","operator":"="}]},{"id":"ccaca2b6-88fd-46e3-ad02-8a414ecb5ca2","order":111,"text":"The Caregiver shall not transport the Care Recipient while impaired by alcohol or by any drug, shall observe all traffic laws, shall ensure that the Care Recipient is properly secured, and shall report any accident or citation to the Care Recipient without delay.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Caregiver's vehicle","type":"add","operator":"="},{"field":"fd7afe3a-d9fb-4a01-88d1-c97a7ddc4e36","value":"the Care Recipient's vehicle","type":"add","operator":"="}]},{"id":"617de966-7294-4258-8250-46323f76bf1f","order":112,"text":"16. REPRESENTATIONS, WARRANTIES AND VERIFICATIONS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S16"},{"id":"c462c338-fd03-4547-9641-646f87140655","order":113,"text":"The Care Recipient represents and warrants that the Care Recipient has the capacity to enter into this Agreement or acts by a duly authorized agent; that the funds used to pay the compensation are the Care Recipient's own and are not encumbered or held for another; that the Care Recipient is able to pay the compensation as it falls due; and that no other agreement, insurance policy or public program provides for payment to the Caregiver for the same Services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"d510d6d2-d1ea-47a9-8c7d-485f3e003f2b","order":114,"text":"The Caregiver represents and warrants that the Caregiver is lawfully authorized to work in the United States and, where engaged as a household employee, shall complete a Form I-9 and produce the supporting documents on or before the first day on which Services are rendered; that the Caregiver holds every license, certificate or registration required to render the Services; that the Caregiver has not been convicted of an offense involving violence, dishonesty, controlled substances, or the abuse, neglect or exploitation of a child or of a vulnerable adult; that the Caregiver is not listed on any state abuse, neglect or exploitation registry, on any sex offender registry, or on any federal or state list of persons excluded from participation in health care programs; and that the Caregiver is physically and mentally able to render the Services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"97ba6523-6071-4465-9811-f3d7205f03e1","order":115,"text":"The Caregiver consents to a criminal history record check, a check of the applicable registries and exclusion lists, and, where the Caregiver is to drive, a check of the Caregiver's driving record, in each case before the Services begin and at reasonable intervals afterwards. The Care Recipient shall bear the cost of those checks, shall use the results only to assess the Caregiver's suitability, and shall keep them confidential.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"f90f033b-88a9-4671-bd27-21de4e254c07","order":116,"text":"Each Party shall notify the other in writing, without delay, of any change that makes a representation in this Article inaccurate, including any charge, conviction, registry listing, license suspension or medical condition affecting the ability to render or to receive the Services.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"bd453ac9-ecbd-4159-8794-d8b048d45576","order":117,"text":"Each Party represents that entering into this Agreement does not breach any other agreement, court order or fiduciary duty binding upon that Party.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"71f5d1ad-741b-481c-99eb-abb85bce0286","order":118,"text":"17. STANDARD OF CARE AND COVENANTS OF THE CAREGIVER","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S17"},{"id":"d13a1c95-dc3d-426d-a0f4-ccda48c1f997","order":119,"text":"The Caregiver shall render the Services with the degree of care, skill, patience and diligence that a reasonably prudent caregiver would exercise, shall at all times treat the Care Recipient with dignity and respect, and shall preserve the Care Recipient's privacy, autonomy and right to make decisions.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"37b7a9fb-075f-4f0b-a5b8-7f39a28a9b60","order":120,"text":"The Caregiver shall not abuse, neglect, exploit, isolate or unreasonably restrain the Care Recipient, and shall not withhold food, medication, care or contact with family, friends or advisers. The Caregiver acknowledges that the abuse, the neglect and the financial exploitation of a vulnerable adult are punishable under the law of Ohio and that suspected abuse may be reported to the adult protective services agency of that jurisdiction.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4cffd208-2045-4c41-998d-1e795944db87","order":121,"text":"The Caregiver shall render the Services personally, shall be punctual, shall not be under the influence of alcohol or of any drug that impairs judgment while on duty, and shall not smoke in the Residence or in the presence of the Care Recipient.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"208de767-0c0a-4a0f-b60e-0fe791dc8fea","order":122,"text":"The Caregiver shall notify the Designated Family Contact and, where appropriate, the Care Recipient's physician, of any material change in the Care Recipient's physical or mental condition, of any fall, injury or hospitalization, and of any circumstance that makes the continued provision of care in the Residence unsafe.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ab26e584-ad4a-4b86-b5bd-531e336797a0","order":123,"text":"In an emergency the Caregiver shall call the emergency services without delay and shall thereafter notify the Designated Family Contact as soon as practicable.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4616f257-73fe-49ac-b519-8e57f0ce4754","order":124,"text":"The Caregiver shall comply with all applicable federal, state and local laws in rendering the Services, including any licensing, registration, training or criminal background check requirement applicable to the Caregiver.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"493cb0f5-29aa-43c4-8a74-83b24eab158a","order":125,"text":"18. ABSENCES, RESPITE AND SUBSTITUTE CAREGIVERS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S18"},{"id":"3c1208ce-67d0-4dd5-988e-b484d36ba108","order":126,"text":"The Caregiver shall give the Care Recipient not less than fourteen (14) days' notice of any planned absence and shall give notice of any unplanned absence as soon as reasonably practicable.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"7192c5f6-fdaf-4648-bcb0-9f921c5af709","order":127,"text":"The Caregiver shall not delegate the Services to any other person without the prior written approval of the Care Recipient. Where a substitute is approved, the Caregiver is not entitled to compensation in respect of the hours covered by that substitute unless the Parties agree otherwise in writing.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"fb37562f-3a41-46f2-8cff-035300b42d59","order":128,"text":"The Care Recipient may at any time engage other caregivers, home care agencies or professionals. This Agreement is not exclusive and does not entitle the Caregiver to any minimum number of hours.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"c466958a-b245-4377-a5c4-9b79b98626b2","order":129,"text":"19. PROHIBITED TRANSACTIONS AND CONFLICTS OF INTEREST","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S19"},{"id":"c7b848f7-67d4-42fe-9b68-dade29ef9e37","order":130,"text":"The Caregiver shall not accept any gift, loan, bequest or other benefit from the Care Recipient beyond the compensation and the reimbursement provided by this Agreement, and shall not solicit, encourage or accept any change to the Care Recipient's will, trust, beneficiary designation, deed or power of attorney in the Caregiver's favor.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1e609093-8b8b-4199-a0ab-4fbfa1004af6","order":131,"text":"The Caregiver shall not be added as a joint owner of, or as a signatory on, any account of the Care Recipient; shall not hold or use the Care Recipient's cash, checkbook, debit card or credit card except for purchases made on the Care Recipient's behalf and accounted for under the Article entitled \"Expenses and Reimbursement\"; and shall not borrow from the Care Recipient.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"bbe2365c-7559-43b7-9e33-98a89a4e9b3b","order":132,"text":"Where the Caregiver also acts, or is named to act, as the Care Recipient's agent under a power of attorney, as trustee or in any other fiduciary capacity, the Caregiver acknowledges the conflict of interest inherent in that position. In that event the Care Recipient should be represented in the negotiation and the execution of this Agreement by an independent person, such as a successor agent, a family member who is not the Caregiver, or an attorney, and the compensation should be reviewed by that person.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1cb57a07-9018-4e11-9ef2-54858eeae47e","order":133,"text":"The Caregiver shall promptly disclose to the Care Recipient and to the Designated Family Contact any circumstance giving rise to an actual or a potential conflict between the Caregiver's interests and those of the Care Recipient.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"437e71a1-2258-43fc-b563-aa6e6d6bb1dc","order":134,"text":"20. CONFIDENTIALITY AND PROTECTED HEALTH INFORMATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S20"},{"id":"e65ee84c-cee9-4815-8dc6-af5f18171ae3","order":135,"text":"The Caregiver shall keep confidential all information concerning the Care Recipient's health, finances, family and personal affairs, and shall not disclose it to any person except so far as is necessary to render the Services, as directed by the Care Recipient, or as required by law. This obligation survives the termination of this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"f0f2030d-5ce6-45ce-a64d-2479243ac2ad","order":136,"text":"The Care Recipient authorizes the Care Recipient's physicians, hospitals, pharmacies, health plans and other providers to disclose to the Caregiver the protected health information necessary for the Caregiver to render the Services. This authorization is given for the purposes of 45 C.F.R. § 164.508, and may be revoked by the Care Recipient at any time by written notice, except to the extent that action has already been taken in reliance upon it. Where a provider requires a separate authorization form, the Care Recipient shall execute it.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"52ed34e3-1001-4364-bc94-edfdaf5452c2","order":137,"text":"The Caregiver shall not photograph, record or publish any image, recording or account of the Care Recipient, including upon any social medium, without the Care Recipient's prior written consent.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"794595ea-eae8-4c87-ba34-cd605c45b73c","order":138,"text":"21. INSURANCE AND INDEMNIFICATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S21"},{"id":"7714b08f-4dba-49d3-953c-e88f28059a16","order":139,"text":"The Care Recipient shall maintain homeowner's or renter's insurance covering the Residence and shall notify the insurer of the presence of the Caregiver where the policy so requires.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"650a3a9e-7c85-4753-b7f9-af087907d517","order":140,"text":"Where the law of Ohio requires a household employer to carry workers' compensation insurance or to participate in a state disability, unemployment or paid family leave program in respect of a household worker, the Care Recipient shall comply with that requirement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"b5b5726a-a344-437e-9692-ac7942da8c95","value":"as an independent contractor","type":"remove","operator":"="}]},{"id":"0a01cbb5-2c47-4840-80ee-b039f76da3f7","order":141,"text":"Each Party shall indemnify and hold harmless the other against any loss, claim, liability or expense arising out of that Party's own negligence, willful misconduct or breach of this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1c655dac-4b86-4a11-895b-03d90e5274ef","order":142,"text":"Neither Party shall be liable to the other for any indirect, incidental, special, punitive or consequential damages arising out of this Agreement. Nothing in this Agreement limits or excludes any liability that cannot lawfully be limited or excluded, including liability for personal injury caused by negligence, for abuse or neglect, or for fraud.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"9a92102c-0fd8-4d19-88b2-b0ef13b9e58e","order":143,"text":"22. FORCE MAJEURE AND SUSPENSION OF THE SERVICES","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S22"},{"id":"902d451b-4c40-4916-ab55-9dbc04a13474","order":144,"text":"Neither Party is liable for a failure or a delay in performing an obligation under this Agreement, other than an obligation to pay a sum already accrued, where the failure or the delay is caused by an event beyond that Party's reasonable control, including a natural disaster, a fire, a flood, a severe storm, an epidemic or other public health emergency, an act or an order of a public authority, a failure of the utilities, or the sudden and serious illness of the Caregiver.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"13b6dfc1-1c22-40ef-89b0-ed82a6b255c8","order":145,"text":"The Party affected shall notify the other as soon as reasonably practicable, shall describe the effect on the Services, and shall use reasonable efforts to resume performance. The Caregiver shall use reasonable efforts to arrange, and the Care Recipient shall use reasonable efforts to accept, substitute care so that the Care Recipient is not left without assistance.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"b3e4db62-9426-46bf-b4d3-b38725ab9c93","order":146,"text":"No compensation accrues in respect of Services that are not rendered during a suspension, but the Care Recipient shall pay all compensation and reimbursement accrued before it. Where a suspension continues for more than thirty (30) consecutive days, either Party may terminate this Agreement by written notice, without further liability other than for sums already accrued.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"f336586e-6cb3-4f69-820b-7f1c19540870","order":147,"text":"23. TERMINATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S23"},{"id":"13896ee7-c1a7-4003-a49b-1feefbef5a17","order":148,"text":"Either Party may terminate this Agreement at any time, with or without cause but not for a reason prohibited by law or by this Agreement, by giving the other not less than [Number of days] days' written notice.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"33ee4e41-47ab-49a7-8a65-946fe851bdf3","order":149,"text":"Either Party may terminate this Agreement immediately by written notice where the other Party has materially breached it; where the Caregiver has abused, neglected or financially exploited the Care Recipient; where the Caregiver has been convicted of an offense that makes the continued rendering of the Services unsuitable; where the Caregiver has become unable to render the Services; or where the Care Recipient's needs can no longer safely be met in the Residence.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"58cdba69-3af2-4340-9fc2-b5f7c43e7b75","order":150,"text":"This Agreement terminates automatically upon the death of either Party and upon the permanent admission of the Care Recipient to a nursing facility or to any other long-term care institution.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ae6ca2af-ff11-4db7-9f42-10db21767ec9","order":151,"text":"Upon termination the Caregiver shall deliver to the Care Recipient the Care Log, all keys, documents, records and property of the Care Recipient in the Caregiver's possession, and a final invoice. The Care Recipient shall pay all compensation and reimbursement accrued and unpaid to the date of termination within fourteen (14) days of receipt of that final invoice. No further sum is payable.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"77d4bd85-dd26-4261-a267-e12eda4f9226","order":152,"text":"24. EFFECT OF THE DEATH OF THE CARE RECIPIENT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S24"},{"id":"62608600-8057-4d89-8bc6-07e418d5e8d3","order":153,"text":"Upon the death of the Care Recipient the Caregiver's entitlement is limited to the compensation and the reimbursement accrued and unpaid in respect of Services actually rendered before the death, which shall be presented as a claim against the estate in the manner and within the time required by the law of Ohio.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"a17e1247-67fb-4bec-9c82-7c34c4ce2611","order":154,"text":"This Agreement confers no interest in the Care Recipient's estate, no right to any specific asset and no right to occupy the Residence after the death of the Care Recipient. It is not a will, a trust or any other testamentary instrument.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"6b93ce56-d3cc-4d65-b9b0-efe39fe4af5f","order":155,"text":"25. COOPERATION WITH APPLICATIONS FOR BENEFITS AND EFFECT ON OTHER BENEFITS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S25"},{"id":"f095e866-bdfa-4358-8d01-7f7490cebdb0","order":156,"text":"Each Party shall cooperate promptly and in good faith with any application made by or for the Care Recipient for Medicaid, for benefits administered by the Department of Veterans Affairs, under a long-term care insurance policy or for any other benefit. The Caregiver shall provide copies of the Care Log, of the invoices and of the records of payment, shall answer reasonable inquiries from the State Medicaid Agency or from another authority, and shall execute a truthful affidavit or certification describing the Services rendered and the compensation received.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4147a480-a3b9-45d6-b751-2c20106023d7","order":157,"text":"That obligation survives the termination of this Agreement and continues for so long as the payments made under it may fall within a Look-Back Period.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"d4fc2edb-9f2c-4ce5-9da0-615a0a1918a3","order":158,"text":"The Caregiver acknowledges that the compensation is earned income, that it may reduce or eliminate the Caregiver's own eligibility for means-tested benefits and tax credits, and that it may affect Social Security retirement benefits received before full retirement age. The Caregiver has been advised to obtain independent advice on those effects.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"efcdd3fa-d6e6-4d79-9f29-7499775e3f2b","order":159,"text":"Where either Party furnishes lodging or meals to the other, the Parties acknowledge that this may constitute in-kind support and maintenance for the purposes of the Supplemental Security Income program, and that the amounts fixed by this Agreement are intended to represent fair market value so far as that consequence can properly be avoided.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"52cd812b-7c62-4853-b063-1c1e915d42af","order":160,"text":"Neither Party shall make, or cause to be made, any false or misleading statement to a public authority concerning this Agreement, the Services rendered or the payments made. The Parties acknowledge that doing so may be a criminal offense and may result in the recovery of benefits paid.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"cb99c301-c771-4cb2-87a4-938a4aae92e5","order":161,"text":"26. NO GUARANTEE OF PUBLIC BENEFITS AND INDEPENDENT ADVICE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S26"},{"id":"980872a5-f50c-49f0-af9f-b44ba6befa24","order":162,"text":"Neither Party makes any representation or warranty that this Agreement, or any payment made under it, will be accepted by the State Medicaid Agency, by the Social Security Administration or by any other authority as a transfer for fair market value, or that the Care Recipient will qualify for Medicaid or for any other public benefit.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"46a1ff15-3a73-4a44-80eb-271bf2c3e2a3","order":163,"text":"Eligibility rules differ from state to state. Some states restrict or refuse to recognize payments made to a family member, require that the caregiver be paid only as the services are rendered, require that the agreement be notarized or witnessed, limit compensation by reference to a published rate schedule, or require that the agreement be supported by a physician's statement of need. Each Party has been advised to consult an attorney experienced in elder law in Ohio and a qualified tax adviser before signing, and has had the opportunity to do so.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"c72356b1-81b9-4aed-aa24-f77dfbf2023e","order":164,"text":"Each Party has read this Agreement, understands it, and enters into it in reliance upon that Party's own judgment and advisers and not upon any statement of the other Party.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"2423c750-2368-4116-99fe-cb528ff0e5b7","order":165,"text":"27. NOTICES","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S27"},{"id":"e2fe96b9-b829-4131-8b8c-ec4afe8be3c4","order":166,"text":"Every notice under this Agreement shall be in writing and shall be delivered personally, sent by a nationally recognized overnight courier, or sent by first class mail with postage prepaid, addressed to the receiving Party at the address stated at the beginning of this Agreement or at such other address as that Party has notified in writing.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"c6511de3-b795-49f4-ac18-409eb11b4f91","order":167,"text":"A notice takes effect upon delivery where it is delivered personally, on the first Business Day after dispatch where it is sent by overnight courier, and on the third Business Day after mailing where it is sent by mail. Notice may in addition be given by electronic mail, but electronic mail alone is not sufficient for a notice of termination.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"c7f33ca8-32a6-4501-af4f-fe3a3fb59a39","order":168,"text":"28. GOVERNING LAW AND RESOLUTION OF DISPUTES","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S28"},{"id":"187eb117-6260-45a7-8a67-bf5d7c68156f","order":169,"text":"This Agreement is governed by, and shall be construed in accordance with, the law of Ohio, without regard to its conflict of laws rules.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"355766cc-87f1-4a7b-a699-611ecc0b92e2","order":170,"text":"The Parties shall attempt in good faith to resolve any dispute arising out of or relating to this Agreement by direct discussion and, failing that, by mediation before a single mediator, the cost of the mediation being borne equally.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"06381915-6564-4d74-ba65-86d04255b1ab","order":171,"text":"Any dispute not resolved by mediation shall be determined by binding arbitration.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"dbc7df89-7961-4fa6-a95a-04fe817fad0b","order":172,"text":"The arbitration shall be administered by the American Arbitration Association under its rules applicable to consumer or commercial disputes, before a single arbitrator, and shall be seated in the county in which the Care Recipient resides. Judgment upon the award may be entered in any court of competent jurisdiction. Nothing in this provision prevents either Party from applying to a court for injunctive relief, from reporting suspected abuse to the authorities, or from bringing a claim within the jurisdictional limit of a small claims court.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"32ee1bbc-a792-4146-aad6-f1abc09d3c10","value":"by binding arbitration","type":"add","operator":"="}]},{"id":"6ae67306-c307-440d-b4f3-7828f90c4321","order":173,"text":"The dispute shall be determined by the state or federal courts sitting in Ohio, to whose exclusive jurisdiction the Parties submit, and each Party waives any objection founded upon venue or forum non conveniens. Nothing in this provision prevents either Party from reporting suspected abuse to the authorities.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"32ee1bbc-a792-4146-aad6-f1abc09d3c10","value":"by the courts","type":"add","operator":"="}]},{"id":"7b168003-429e-4a3b-91b9-4d89b778dc08","order":174,"text":"Each Party shall bear its own costs and attorneys' fees, except where an award of costs or fees is made by the arbitrator or by the court in accordance with applicable law.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"14cc0b09-9880-4e15-9673-54d82f0b635d","order":175,"text":"29. GENERAL PROVISIONS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"marginTop":"22","sectionNum":"S29"},{"id":"5e24f854-fff9-4a24-baff-7467c61e1806","order":176,"text":"This Agreement constitutes the entire agreement between the Parties in respect of its subject matter and supersedes all prior discussions, understandings and agreements, whether oral or written, concerning the compensation of the Caregiver.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"8dd2b945-da1b-436b-bf09-64ef4ede20ea","order":177,"text":"No amendment to this Agreement is effective unless it is in writing, signed by both Parties and dated. An amendment operates prospectively only, and no amendment shall increase the compensation payable in respect of services already rendered.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"5fbc69f0-79f0-48d7-9e54-f6a9115e6d8f","order":178,"text":"No failure or delay by a Party in exercising a right under this Agreement operates as a waiver of that right, and no single or partial exercise of a right prevents any further exercise of that or of any other right.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"edde3df1-3fbb-4d2c-a27a-327dc9db9b07","order":179,"text":"Neither Party may assign this Agreement or delegate the performance of its obligations under it. The Services are personal to the Caregiver.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"7a944fe1-692b-4d7d-be78-a31515caa44c","order":180,"text":"If any provision of this Agreement is held invalid, illegal or unenforceable, that provision shall be modified to the least extent necessary to render it enforceable or, if it cannot be so modified, shall be severed, and the remaining provisions shall continue in full force and effect.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"86d80329-8bec-4b9d-8e23-0e00bb37fcf5","order":181,"text":"The headings of the Articles are for convenience only and do not affect the construction of this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"d6932ab1-55e1-4be4-96d6-aa9ba08648e8","order":182,"text":"This Agreement may be executed in counterparts and delivered by electronic means, and an electronic signature has the same effect as a manuscript signature to the extent permitted by the Electronic Signatures in Global and National Commerce Act, 15 U.S.C. § 7001, and by the law of Ohio.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"d725fbe4-fe6c-4fde-bc2a-4390847959ec","order":183,"text":"This Agreement is binding upon and inures to the benefit of the Parties and their respective heirs, executors, administrators, personal representatives and permitted successors. It confers no right upon any third party.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"7b512026-4218-4ec4-98eb-b73911a902d1","order":184,"text":"Nothing in this Agreement creates a partnership, a joint venture or a fiduciary relationship between the Parties.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ac4040d3-484c-4590-b5be-59c4442e5df3","order":185,"text":"The provisions of this Agreement concerning confidentiality, protected health information, records, indemnification, prohibited transactions, governing law and the resolution of disputes survive its termination.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"16f7de36-9dc5-41fb-8ec4-92e85e0f72a7","order":186,"text":"30. 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and having authority under the durable power of attorney to bind the Care Recipient to it.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"536ca3c1-858a-4e1b-9c71-19eb1207d61e","value":"by agent","type":"add","operator":"="}]},{"id":"3b775453-53b9-4897-8890-e015244c13b9","order":189,"text":"The Caregiver acknowledges having read this Agreement in full, understands its terms, and signs it freely and voluntarily.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"2ccd6345-8437-4401-b277-3d3c62e2de8d","order":190,"text":"IN WITNESS WHEREOF, the Parties have executed this Agreement as of the Effective Date.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"18","cflou":false,"active":true},{"id":"b12f77d3-513e-471c-8526-4fb24002b6d6","order":191,"text":"THE CARE 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______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"18","cflou":false,"active":true,"displayConditions":[{"field":"536ca3c1-858a-4e1b-9c71-19eb1207d61e","value":"personally","type":"add","operator":"="}]},{"id":"adf7a046-0148-4914-8424-d41d0bd99132","order":195,"text":"_______________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true,"displayConditions":[{"field":"536ca3c1-858a-4e1b-9c71-19eb1207d61e","value":"by agent","type":"add","operator":"="}]},{"id":"33162105-bfe5-4b3f-952e-0ddade69e51b","order":196,"text":"[Full legal name of the agent], as agent under durable power of attorney for [Full legal name of the Care Recipient]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true,"displayConditions":[{"field":"536ca3c1-858a-4e1b-9c71-19eb1207d61e","value":"by 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Each states that this Agreement was signed in the witness's presence by the person or persons whose signatures appear above, who appeared to the witness to be of sound mind and to be acting free of duress and of undue influence.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"12","cflou":false,"active":true},{"id":"c44e69da-bff9-4a37-ae47-5740e3316e2e","order":204,"text":"Witness signature: _______________________________ Printed name: _______________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"0e435975-d2b4-4157-b177-b6a5f31a3c73","order":205,"text":"Witness signature: _______________________________ Printed name: _______________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"18","cflou":false,"active":true},{"id":"fc576254-2c09-4681-9a66-579c9a0360c1","order":206,"text":"ACKNOWLEDGMENT","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"e4c5e806-4b82-4e79-a865-7662d882a36b","value":"notarized","type":"add","operator":"="}]},{"id":"860ea9c6-e0cc-4278-b9ad-e0e62fea64e5","order":207,"text":"State of ______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true,"displayConditions":[{"field":"e4c5e806-4b82-4e79-a865-7662d882a36b","value":"notarized","type":"add","operator":"="}]},{"id":"c61e1ef9-43da-411f-98e8-d8569b03b37d","order":208,"text":"County of ______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"e4c5e806-4b82-4e79-a865-7662d882a36b","value":"notarized","type":"add","operator":"="}]},{"id":"46f4f100-0012-4db3-a633-161a3cfb011a","order":209,"text":"On this ______ day of ______________________, 20____, before me, the undersigned notary public, personally appeared the person or persons who signed the foregoing instrument, known to me or satisfactorily proven to be the individuals whose names are subscribed to it, and acknowledged that they executed it for the purposes therein contained.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"e4c5e806-4b82-4e79-a865-7662d882a36b","value":"notarized","type":"add","operator":"="}]},{"id":"447dad0c-89e1-47c7-b49c-bb6045fae7f0","order":210,"text":"Witness my hand and official seal.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"14","cflou":false,"active":true,"displayConditions":[{"field":"e4c5e806-4b82-4e79-a865-7662d882a36b","value":"notarized","type":"add","operator":"="}]},{"id":"5ac5f574-51f4-4a43-9c88-0498c6f46dd9","order":211,"text":"_______________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true,"displayConditions":[{"field":"e4c5e806-4b82-4e79-a865-7662d882a36b","value":"notarized","type":"add","operator":"="}]},{"id":"b1ec1e00-a516-4191-8752-d132820abf2b","order":212,"text":"Notary Public — my commission expires: ______________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"18","cflou":false,"active":true,"displayConditions":[{"field":"e4c5e806-4b82-4e79-a865-7662d882a36b","value":"notarized","type":"add","operator":"="}]},{"id":"34d05860-1166-4b57-a02f-a83847d505ff","order":213,"text":"SCHEDULE A — RECORD OF SERVICES (CARE LOG)","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"24"},{"id":"dac76ccc-f4ad-42de-8a0d-a72fa6fbe09b","order":214,"text":"The Caregiver shall complete one entry in this form for each day on which Services are rendered, and shall retain the completed record together with the invoices and the records of payment. This Schedule forms part of this Agreement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"12","cflou":false,"active":true},{"id":"1bf38902-d1f5-4325-a11b-4d8d410c8e07","order":215,"text":"Date — Time started — Time ended — Total hours — Services rendered — Notes or incidents — Initials of the Caregiver","fontSize":"12","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"d4a9e845-cc9a-42c4-9e5b-b8ef7ed5eb98","order":216,"text":"________ ________ ________ ________ ____________________________ ____________________ ________","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"bfccf0e1-7926-48c3-a263-39de8b209e85","order":217,"text":"________ ________ ________ ________ ____________________________ ____________________ ________","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"fca0ccef-d464-4aad-a84f-ba8e7a7dd2b4","order":218,"text":"________ ________ ________ ________ ____________________________ ____________________ ________","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"bcf12bde-4c21-40dc-ab8a-f7cc2854a627","order":219,"text":"________ ________ ________ ________ ____________________________ ____________________ ________","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"eefbc645-b7e4-4b10-b24a-f06bbdf2dbad","order":220,"text":"________ ________ ________ ________ ____________________________ ____________________ ________","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"df70d440-5be0-444c-a007-2d1be2222f29","order":221,"text":"________ ________ ________ ________ ____________________________ ____________________ ________","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"070a8598-9e5b-4899-84eb-fb19419269a7","order":222,"text":"________ ________ ________ ________ ____________________________ ____________________ ________","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"e06b2c3d-d112-49b9-8a49-f4223c02acfa","order":223,"text":"________ ________ ________ ________ ____________________________ ____________________ 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Parties;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"ee4fe996-d2bb-46f4-a57c-8bf8d29326b6","order":230,"text":"— the completed Care Log for every period;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"dfb03b05-7e99-4a87-80fc-684c6c1d7601","order":231,"text":"— every invoice delivered by the Caregiver;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"4b41f35f-d321-48b5-9e0b-7c520d4be874","order":232,"text":"— the cancelled checks, the bank statements or the electronic transfer confirmations evidencing every payment;","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"12b8eb38-b790-4508-9e9e-4b14c902edc2","order":233,"text":"— the receipts supporting every reimbursed expense and every mile 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