Shifa Home Health Care Service Agreement

Patient Name

Family Member

CNIC Number

Required Shift

Agreement Date

Mobile No.

Address

Terms And Conditions

#	Contractual Requirement / Provision
01	Provide accurate and up-to-date medical history and relevant information.
02	Follow the prescribed medical treatment plan and cooperate with staff.
03	Notify the Provider of any changes in health status or medications.
04	Maintain a safe and clean environment for nursing services.
05	Ensure necessary equipment or supplies are available for care.
06	A 15-day payment is required in advance to initiate nursing services.
07	Charges (12h): ICU Nurse: 4,000 | Nurse: 3,500 | Tech: 3,000 | Attendant: 2,000. | Post RN Bscn: 4,500.
08	Payments should be completed every 15 days (mid and end of month).
09	Management has the right to change staff. Interference is strictly prohibited.
10	Directly dealing with staff results in legal action and forfeiture of advance.
11	To discontinue services, inform management 5 days in advance.
12	Family must provide lunch for day duty staff; otherwise meal charges apply.
13	The provider is not responsible for incidents outside the scope of services.

IMPORTANT NOTE

• •Never pay staff directly without asking management; otherwise, management is not responsible.
• •Never discuss payment matters with company staff.
• •Keep personal items (Jewellery, Cash etc) out of patient room. We are not responsible for loss.
• •Never allow staff outside the patient room; otherwise, management is not responsible for loss.
• •Per Gov of Sindh, company does police verification (criminal record basis only).
• •Shifa team has verbally informed me about this entire agreement.
• •Service discontinued without notice, 3 Days payment will be deducted.

Admin Seal/Sign

Management Signature

Client Name/Sign

Client Signature