SALUD HOME CARE CLIENT SERVICE AGREEMENT ADDENDUM 2026

1. Click ‘Get Form’ to open the SALUD HOME CARE CLIENT SERVICE AGREEMENT ADDENDUM in the editor.
2. Begin by entering the patient's name in the designated field labeled 'Patient: _________'.
3. Fill in the date and relevant medical record number (MR #) and SOC in their respective fields.
4. Review the section regarding changes to your Plan of Care. If applicable, indicate the new frequency of visits by filling out the 'New Frequency' section.
5. List any disciplines affected by these changes in the 'Discipline/Disciplina' section.
6. If there are charge changes, provide a detailed explanation in the 'Charge changes, explain:' field. If not applicable, select 'N/A'.
7. Confirm that your physician approved the changes by checking the appropriate box. Then, acknowledge acceptance of these changes by signing at the bottom as a patient or representative.
8. Finally, ensure that both you and an agency representative sign and date where indicated before saving or exporting your completed document.

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