Healthcare Housing Contract

HEALTHCARE HOUSING CONTRACT

PARTIES AND IDENTIFICATION

This Healthcare Housing Contract ("Contract") is entered into between Facility Name: , Facility Address: and Resident Name: (hereinafter "Resident"). The parties agree to the terms and conditions set forth below.

PATIENT / RESIDENT INFORMATION

INSURANCE AND PAYMENT

Payments are due in advance on the first day of each month. Resident authorizes Facility to bill insurance where applicable and to invoice Resident for fees not covered by insurance. Late fees, refund and deposit handling are governed by the Fees and Refunds clause below.

TERM, OCCUPANCY AND SERVICES

Term Commencement Date: . Either party may terminate this Contract in accordance with the Termination provisions herein. Occupancy is limited to the Resident named in this Contract and any persons approved in writing by Facility.

Facility will provide the following services as part of the housing arrangement: nursing assessment, medication oversight as specified, assistance with activities of daily living as agreed, coordination of primary and specialty medical care, housekeeping for common areas, and emergency response. Services not expressly listed are the responsibility of Resident or Resident's insurer.

MEDICAL HISTORY AND CARE COORDINATION

Resident authorizes Facility staff to coordinate care with Resident's health care providers, to obtain necessary medical records, and to facilitate referrals. Authorization for release of health information is included below and shall expire as specified.

AUTHORIZATION AND PRIVACY

By signing this Contract, Resident (or Resident's authorized representative) authorizes Facility to obtain, use, and disclose protected health information for purposes of providing housing-related healthcare services, billing, care coordination, and emergency care. Such disclosures shall be limited to the minimum necessary to accomplish the intended purpose.

Authorization expiration date: . Resident may revoke this authorization at any time in writing, except to the extent that Facility has already acted in reliance on it.

RESIDENT OBLIGATIONS AND PROHIBITIONS

Resident agrees to comply with Facility policies regarding medication management, infection control, smoking, use of alcohol and controlled substances, visitors, and respect for other residents. Facility may require removal of Resident for behavior that endangers others or materially interferes with Facility operations, after notice and in accordance with applicable law.

MAINTENANCE, REPAIRS AND SAFETY

Facility shall maintain premises in a habitable condition and perform ordinary repairs. Resident shall promptly report maintenance issues. Resident shall not make structural changes or install fixtures without prior written consent.

TERMINATION AND DISPUTE RESOLUTION

This Contract may be terminated by Facility for nonpayment, breach of material obligations, or conduct that jeopardizes safety, after providing written notice as required by law. Resident may terminate by providing written notice to Facility at least 30 days prior to departure, unless otherwise agreed. Disputes shall be resolved first by good-faith negotiation; if unresolved, disputes will be submitted to mediation prior to any court action.

LIABILITY, INSURANCE AND INDEMNIFICATION

Facility maintains liability insurance for operations; Resident is encouraged to maintain personal property insurance. Facility is not responsible for loss of personal property except to the extent caused by Facility's gross negligence. Resident shall indemnify and hold Facility harmless from claims arising from Resident's negligence or willful misconduct.

NOTICES

Notices required by this Contract shall be in writing and delivered to the addresses below. Notice delivered by certified mail, return receipt requested, or personal delivery is effective upon receipt.

MISCELLANEOUS

This Contract contains the entire agreement between the parties with respect to housing services described herein and supersedes prior oral or written agreements. Any amendment must be in writing and signed by both parties. If any provision is held invalid, remaining provisions shall remain in effect.

ADDITIONAL AUTHORIZATIONS

CERTIFICATION AND CONSENT

By signing below, Resident (or Resident's authorized representative) certifies that the information provided in this Contract is true and complete to the best of their knowledge, consents to the terms and conditions herein, and acknowledges receipt of applicable notices. Signing constitutes consent to services and to Facility's policies concerning health, safety, and the use of protected health information as described above.

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