Closure Certificate for Case Management

CLOSURE CERTIFICATE FOR CASE MANAGEMENT

RECITALS

WHEREAS Provider Name: provides case management services to individuals and entities pursuant to the terms set forth herein; and

WHEREAS Client Name: is the recipient of those services in relation to Case ID: ; and

WHEREAS the parties wish to document the formal closure of case management services and to set forth final certifications, outstanding financial obligations, and continuing obligations after closure effective on Effective Date: .

SCOPE OF WORK AND FINAL SUMMARY

CLOSURE FINDINGS

The undersigned certifies that the following closure criteria were reviewed and applicable items are checked:

Goals and service objectives substantially achieved

Client transferred to alternate provider with documented warm handoff

Client declined further services after informed offer

Client unreachable following documented outreach efforts

Other (explain):

FINAL DOCUMENTATION & TRANSFERS

The following final actions have been completed: final progress notes filed, risk assessments updated, and necessary records transferred or archived in accordance with agency policy. All required client consents for disclosure have been obtained where applicable.

PAYMENT TERMS

All outstanding fees and expenses accrued through the Case Closure Date are immediately payable in accordance with the schedule above. Failure to remit payment when due constitutes breach and may result in collection action and accrual of the specified late fee or interest.

TERM AND TERMINATION

This Certificate documents closure of services rendered under the engagement that commenced on Start Date: and terminated on End Date: .

Termination prior to the documented End Date shall require written notice in accordance with the notice period above. Rights and obligations that by their nature survive termination, including payment obligations and confidentiality, shall continue as provided in this Certificate.

CONFIDENTIALITY

Each party acknowledges that, in the course of performance, it may obtain confidential or proprietary information of the other party. Such information shall be maintained in confidence for a period of five (5) years following closure, except where a longer period is required by law, professional regulation, or third‑party contract. Confidential information does not include information that (a) is or becomes public without breach of this Certificate, (b) was already in the receiving party's possession prior to disclosure, or (c) is required to be disclosed by law, provided the disclosing party gives prior written notice where legally permissible and cooperates to seek protective measures.

GOVERNING LAW

This Certificate and any dispute arising under or in connection with it shall be governed by and construed in accordance with the laws of Governing State: , without regard to principles of conflict of laws.

ENTIRE AGREEMENT

This Closure Certificate, together with any contemporaneous written amendments executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral. No modification shall be effective unless in writing and signed by authorized representatives of both parties.

CERTIFICATION

By executing below, the undersigned certify under penalty of perjury, where applicable, that the information contained in this Closure Certificate is true, accurate, and complete to the best of their knowledge; that all required records and reports have been completed and retained or transferred as described; and that outstanding financial obligations are disclosed above.

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