Section B — Supplemental Documents ~120 min

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

This step is optional. It is not part of the CDSS application. HCS 281 lists only items B1 to B6. Still, these forms help you serve clients well.

Client Intake: Document how you assess new clients — needs, preferences, medical history, emergency contacts. We suggest doing intake 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. Not part of the CDSS application. HCS 281 Section B lists only B1 to B6. These are good business practice.

What the Law Says

- Who home care is for (§ 1796.12(n)). It is for people who can't do these tasks because of age or disability. Your intake form can note why the client needs help.

- What "client" means (§ 1796.12(c)). A client gets home care from a registered home care aide. Your aides must be on the CDSS registry.

Common Mistakes to Avoid

  • 1Using generic templates that lack agency-specific details
  • 2A service agreement that does not spell out services, fees, and how to cancel
  • 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
    PDF, DOCX · Max 10MB
  • Service Agreement Template
    PDF, DOCX · Max 10MB
  • Care Plan Template
    PDF, DOCX · Max 10MB

Want us to handle this for you?

Our licensing team knows this form inside and out. 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.