Advance Directives: You have the right to create, update, or revoke advance directives (such as Do Not Resuscitate orders). You are encouraged to provide copies to the agency for reference during service.

 Emergency Response: In the event of a medical emergency, our staff will immediately call 911 and notify your designated emergency contact. Caregivers are not permitted to transport clients in private vehicles during emergencies.

 Incident Documentation: All incidents, injuries, hazards, or unsafe conditions will be documented, reported, and reviewed by the agency within 24 hours. Follow-up actions will be taken as needed.

 Caregiver Assignment: You may accept or decline any caregiver assigned. We aim to provide consistent, well-matched, and compassionate staff based on your preferences and care needs.

 Complaint Procedures: You have the right to file a grievance or concern at any time. All complaints will be investigated and responded to promptly and without retaliation. You may also call the MD Department of Health Complaint Hotline at 1-877-402-8218.

 Referrals: Ambition HomeCare LLC will disclose whether a referred caregiver is appropriately trained, cleared, and suitable for your care needs in accordance with Maryland law.

 Infection Control: We follow strict infection prevention measures including caregiver hand hygiene, equipment sanitation, and use of personal protective equipment (PPE) as needed.

 Privacy & HIPAA Compliance: Your personal, health, and identifying information will be kept confidential and secured in compliance with federal and state HIPAA guidelines.

 Service Limitations: As a non-medical agency, we do not provide medical diagnosis, clinical treatment, or medication administration. Services are limited to supportive, non-medical care.

 Communication: You will be notified of any changes in agency hours, policies, assigned caregivers, or service rates. The agency may contact you or your emergency contact via phone, text, email, or written notice.

 Scheduling Policy: While we do our best to fulfill all care requests, schedule changes must be made with a minimum of 24 hours’ notice. Emergency coverage is subject to caregiver availability.

 Service Termination: The agency reserves the right to discontinue services due to non-payment, unsafe conditions, client misconduct, or failure to follow the care agreement. You will be given written notice when possible.

By signing below, I acknowledge that I have read and understand the above policies and legal disclosures:

I consent to the collection, use, storage, and processing of my personal and, where applicable, health-related information, including any data I submit on behalf of others, for the purpose of evaluating or fulfilling my request made through this form. I understand this will be handled in accordance with the Privacy Notice.