Concern Form

Through K.K. Health At Home Services, I have arranged caregiving services for my patient mentioned above. A caregiver will stay at my home for exclusive care and will perform the following duties: • Changing diapers • Sponging • Administering medication on time • Checking vital signs • Feeding the patient The caregiver will NOT perform household work like sweeping, mopping, washing dishes, or running errands. I agree to pay the selected package amount as discussed. Membership amount is non-refundable and non-adjustable. Medical risks are understood and I will not hold K.K. Health legally responsible. Monthly payment receipts will be shared via WhatsApp or Email. Medical records may be stored electronically. Replacement staff will be provided in case of emergency. Health insurance reimbursement (if applicable) is patient responsibility. I understand all responsibilities of General Duty Assistant (GDA) including hygiene care, nutrition care, mobility support, catheter care, infection control, etc. I agree to all rules and company policies.