Personal Care Agreement - California

California · Fillable PDF · Free

A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Medi-Cal long-term care planning, so payments are not treated as gifts. A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Medi-Cal long-term care planning, so payments are not treated as gifts.

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Who this form is for

• A written, signed personal care agreement documents that a family member or friend is paid for providing care. It is often needed for Medi-Cal long-term care planning, so payments are not treated as gifts.

What you'll need

• Read the original packet's instructions and check the receiving agency's requirements.
• Have the requested document details and acceptable identification ready.

How to complete it

1. Describe the care (Page 1) List the services, schedule, and a reasonable rate of pay.
2. Both sign before a notary A notarized, dated agreement is strong proof of when it was made. Bring a current, government-issued photo ID.

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These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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