Personal Care Agreement - North Carolina

Download Personal Care Agreement - North Carolina PDF

North Carolina · 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 NC Medicaid 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 NC Medicaid long-term care planning, so payments are not treated as gifts.

Serving North Carolina. Our mobile notaries serving North Carolina are commissioned in North Carolina and travel to your home, office, hospital, or other convenient location.

Book a notary for Personal Care Agreement - North Carolina

Using this document abroad?

You may need an apostille. We can help.

Check our apostille service pricing, see the destination countries we assist with, and learn how to get started.

View Apostille Pricing & Countries

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 NC Medicaid long-term care planning, so payments are not treated as gifts.

What you'll need

Read the packet and check the receiving agency's required form.
Gather the names, dates and supporting records requested in the document.
Review the packet's signing, identification and witness instructions.

How to complete it

Describe the care (Page 1) List the services, schedule, and a reasonable rate of pay.
Both sign before a notary A notarized, dated agreement is strong proof of when it was made. Bring a current, government-issued photo ID.
Keep the agreement and the care log with your records. Medicaid rules are complex; talk to an elder law attorney.

Related North Carolina forms

North Carolina · Fillable PDF · 3 pages · Free

Authorization to Consent to Health Care for Minor - North Carolina

North Carolina law lets a parent authorize another adult, such as a grandparent, relative, or caregiver, to consent to medical, dental, and other health care for a child while the parent is unavailable.

View Authorization to Consent to Health Care for Minor - North Carolina · Download Authorization to Consent to Health Care for Minor - North Carolina

North Carolina · Fillable PDF · 3 pages · Free

Minor Child Travel Consent - North Carolina

When a child travels with only one parent, grandparents, a school group, or another adult, airlines and border officials may ask for written, notarized consent from the parents who are not traveling.

View Minor Child Travel Consent - North Carolina · Download Minor Child Travel Consent - North Carolina

North Carolina · Fillable PDF · 3 pages · Free

Nomination of Guardian - North Carolina

This form lets you tell a North Carolina court who you want as your guardian (personal care) and conservator (money and property) if you ever become unable to manage your own affairs, and who should never serve.

View Nomination of Guardian - North Carolina · Download Nomination of Guardian - North Carolina

North Carolina · Fillable PDF · 3 pages · Free

Pet Care Designation - North Carolina

This form names who will take care of your pets if you die or cannot care for them, with instructions for their care.

View Pet Care Designation - North Carolina · Download Pet Care Designation - North Carolina

North Carolina · Fillable PDF · 3 pages · Free

Standby Guardian Designation - North Carolina

A North Carolina parent with a progressive chronic illness, an irreversible fatal illness, or another qualifying circumstance can designate a standby guardian to care for a child if the parent dies or becomes unable to care for the child.

View Standby Guardian Designation - North Carolina · Download Standby Guardian Designation - North Carolina

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.

Free legal forms by state · Book a mobile notary