MCN’s customizable template, Agreement for Services Form, is taken from our Home Care Corporate Compliance Manual. MCN Healthcare’s proven policy and procedure templates, competencies and compliance tools have assisted more than 20,000 health care organizations worldwide meet their regulatory compliance goals.

MCN provides more than 80 health care specific policy and procedure manuals for Acute Care Hospitals, Ambulatory Care, Behavioral Health, Home Health, Physician Practice, and Long Term Care. MCN’s policy and procedure manuals focus on the latest healthcare "hot topic" issues related to patient safety and prevention of medical healthcare errors.

Here is some sample content from Agreement for Services Form:

	AGREEMENT FOR SERVICES This organization requests the identified nature, scope and type of care/service be provided by the below named organization/individual. The organization expects that the care/service provided will be carried out by qualified personnel that meet or exceed organization standards and that the care/service will adhere to practice guidelines and any and all applicable laws, regulations, guidelines and standards. It is understood that the care/service provided will be appropriate for the patient as evidenced by written documentation, and will be coordinated with any other...
Second excerpt:
	...for initial and ongoing assessments Responsibility for the Plan of Care/Service Evaluation of the care/service provided Schedule of visits/hours Documentation will be submitted by the organization/individual on the following agreed upon schedule: every two 2 weeks every month every quarter every six 6 months annually The charges and reimbursement schedule is as follows: The conditions for renewal or termination of this agreement are as follows: Any and all...