Acknowledgment of Voluntary Services

The Client acknowledges that they have voluntarily engaged the services of At Home Wellness Concierge Nursing, LLC. The Client understands that concierge nursing services are provided outside of a hospital or medical facility setting and are intended to support needs as agreed upon between both parties. The Nurse does not operate as an emergency care provider, and the Client agrees to seek appropriate medical attention in the event of a health crisis.

The Client affirms that they have independently chosen to receive concierge nursing services and that they may discontinue care at any time. The Nurse makes no guarantees regarding medical outcomes, recovery rates, or improvements in the Client's condition. The Client understands that results may vary and assumes full responsibility for their decision to receive care.

No Guarantee of Medical Results

The Client acknowledges that concierge nursing is provided for comfort, support, health and wellness but does not guarantee any particular health outcome. The Nurse may provide care in accordance with best practices and within their professional scope, but the effectiveness of care depends on various factors beyond their control, including the Client's medical condition, compliance with treatment, and unforeseen health complications.

The Client understands that while the Nurse may provide recommendations based on their training and experience, they are not responsible for the Client's overall medical prognosis. The Nurse is not liable for any failure to achieve expected health improvements or recovery. The Client agrees to work in collaboration with their primary healthcare provider and understands that concierge nursing does not replace ongoing physician care.

Assumption of Risk

The Client understands that receiving concierge nursing care may carry inherent risks, including but not limited to, adverse reactions to treatments, unexpected health deterioration, and complications arising from pre-existing conditions. While the Nurse will exercise due diligence and care, they cannot anticipate all potential medical issues or emergencies.

The Client assumes full responsibility for any risks associated with concierge nursing and releases the Nurse from liability for any adverse effects resulting from care, except in cases of proven gross negligence or intentional harm. The Client agrees to communicate any concerns promptly and to seek emergency medical attention when necessary.

Scope of Practice and Limitations

The Client acknowledges that the Nurse will only provide services within their licensed scope of practice. The Nurse will not perform medical procedures, prescribe medication, or administer treatments beyond their professional authorization. The Client agrees to respect these limitations and seek additional medical care when necessary.

The Nurse is not responsible for diagnosing medical conditions or altering prescribed treatments. If the Client requires a change in their care plan, they must consult their primary healthcare provider. The Nurse's role is limited to assisting with daily medical needs, personal care, wellness and treatment adherence as directed by the Client's physician.

Emergency Situations and Medical Crisis

The Client understands that concierge nursing services do not replace emergency medical care. If a medical emergency arises, the Nurse may provide basic first aid and contact emergency services but is not liable for any delays, complications, or outcomes resulting from an emergency situation.

The Client agrees to have an emergency plan in place, including readily available contact information for their primary physician, preferred hospital, and emergency contacts. The Nurse will not be held responsible for any medical complications that arise while awaiting emergency medical intervention.

Release of Liability

The Client hereby releases and discharges the Nurse from all claims, damages, or liabilities arising from their participation in concierge nursing services. This includes, but is not limited to, injury, illness, complications, or emotional distress resulting from care received. The Client understands that the Nurse is acting in good faith and within their professional capacity.

The Client agrees that this release applies to themselves, their heirs, legal representatives, and assigns. The Nurse shall not be held liable for any damages beyond the scope of services agreed upon.

Confidentiality and Privacy

The Nurse agrees to maintain confidentiality regarding the Client's medical history, treatment plan, and personal information. All details discussed during the provision of care will remain private and will not be shared with third parties unless required by law or authorized by the Client.

The Client understands that while the Nurse takes reasonable precautions to protect their privacy, certain information may be disclosed when necessary for medical coordination or in compliance with healthcare regulations. The Client agrees to communicate any specific confidentiality preferences in writing.

Compensation and Payment Terms

The Client agrees to the payment terms as outlined in the service agreement with the Nurse. Concierge nursing services are provided on a contractual basis, and the Client is responsible for timely payment of all agreed-upon fees. Failure to provide compensation as scheduled may result in the suspension or termination of services.

The Client acknowledges that fees are non-refundable unless otherwise stated in the service agreement. The Nurse reserves the right to discontinue services if payments are not made in accordance with the agreed terms.

Signatures

By signing, the Client confirms they have read and understood this agreement and agree to its terms.

Client name: ______________________________
Client signature: ______________________________ Date: ____________

Nurse: Danielle Barilotti, BSN, RN, for At Home Wellness Concierge Nursing, LLC
Signature: ______________________________ Date: ____________