Section B — Supplemental Documents ~120 min

Client Intake Form, Service Agreement & Care Plan Templates (California)

CDSS expects home care organizations to have documented intake procedures, service agreements, and care plans for each client.

Client Intake: Document how you assess new clients — needs, preferences, medical history, emergency contacts. Intake must occur before services begin. Service Agreement: A written contract between client (or representative) and agency specifying services, schedule, fees, cancellation policy, and client rights. Care Plan: An individualized plan for each client that describes the care to be provided, who will provide it, frequency, and how goals will be monitored.

These documents demonstrate your agency's operational readiness and compliance with CDSS expectations.


What the Law Says

- Who qualifies as a client (§ 1796.12(n)). The law says home care services are for people who "because of advanced age or physical or mental disability, cannot perform these services." Your intake form should document why the client needs help. This is not just good practice — it matches the legal definition.

- "Client" has a specific meaning (§ 1796.12(c)). A "client" is someone who receives home care services from a registered home care aide. Your service agreement should reflect this — the person signing is receiving care from an aide who is on the CDSS registry.

Common Mistakes to Avoid

  • 1Using generic templates that lack agency-specific details
  • 2Not ensuring the service agreement includes all required disclosures (client rights, fees, cancellation)
  • 3Care plans that are too vague to guide care delivery

Tips

  • Have an attorney review your service agreement template
  • Care plans should be updated when client needs change
  • Keep signed copies of all agreements on file

What You Need to Do

  1. 1
    Develop client intake form and procedures
  2. 2
    Create service agreement template with required disclosures
  3. 3
    Create care plan template
  4. 4
    Upload intake form, service agreement, and care plan templates

Information You Will Need

Have these details ready before you sit down to fill this out:

Client Intake Form — Key Sections
Service Agreement — Key Terms
Individualized Care Plan — Structure

Documents Needed

  • Client Intake Form Template
    RequiredPDF, DOCX · Max 10MB
  • Service Agreement Template
    RequiredPDF, DOCX · Max 10MB
  • Care Plan Template
    RequiredPDF, DOCX · Max 10MB

Want us to handle this for you?

Our licensing team knows this form inside and out. For $999, we fill out every form, check every box, and submit the whole packet to CDSS on your behalf. You just answer a few simple questions.

John Helmy

Researched and reviewed by

John Helmy, Founder of HomeCareAtlas

Building tools and resources to help home care agency owners navigate licensing, compliance, and growth.