Service Agreement Template Chsp

SERVICE AGREEMENT: Commonwealth Home Support Programme (CHSP)

Document ID: TR-CHSP-001
Effective Date: [____/____/2026]

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INSTRUCTIONS FOR USE

• Completion: This form must be completed in full by the Service Provider and the Care Recipient (or their authorized representative) prior to the commencement of services.
• Filing & Retention: The signed original must be scanned into the Provider’s secure client management system. Records must be retained for a minimum period of seven (7) years following the cessation of service provision in accordance with Commonwealth reporting standards.
• Attachments: Attach a copy of the Care Plan, the current Fees Schedule, and the Provider’s Privacy Policy to this agreement before signing.

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1. PARTIES

Service Provider: [________________]
Provider ABN: [________________]
Care Recipient: [________________]
My Aged Care ID: [________________]

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2. SERVICE PROVISION

The Provider agrees to deliver the services as outlined in the attached Care Plan.
Service Type:
[ ] Domestic Assistance
[ ] Personal Care
[ ] Home Maintenance
[ ] Social Support
[ ] Other: [________________]

Service Location: [________________]
Commencement Date: [____/____/2026]

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3. FEES AND BILLING

Fees are charged in accordance with the Commonwealth Home Support Programme (CHSP) national guidelines.

• Co-contribution Fee: $[__________] per [__________] (e.g., hour/visit).
• Invoicing Cycle: [ ] Weekly [ ] Fortnightly [ ] Monthly.
• Payment Method: [ ] Direct Debit [ ] EFT [ ] Other: [________________].

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4. SERVICE CANCELLATION POLICY

Cancellations must be communicated to the Provider with at least [__________] hours of notice. Failure to provide adequate notice may result in the following:
[ ] No charge
[ ] Full fee charged
[ ] Partial fee charged: [__________]

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5. PRIVACY AND DATA PROTECTION

The Provider collects and manages personal information in accordance with the Privacy Act 1988 (Cth). Information will only be disclosed to the Department of Health and Aged Care for reporting purposes or as required by law.
Consent to disclose data: [ ] Yes [ ] No

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6. TERMINATION OF AGREEMENT

Either party may terminate this agreement by providing [__________] days' written notice. The Provider may terminate immediately in instances of staff safety concerns or breach of conduct.

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7. EXECUTION

By signing below, the parties confirm they have read, understood, and agreed to the terms of this Service Agreement.

Service Provider Representative:
Signature: ____________________
Printed Name: [________________]
Title: [________________]
Date: [____/____/2026]

Care Recipient / Authorized Representative:
Signature: ____________________
Printed Name: [________________]
Relationship to Recipient: [________________]
Date: [____/____/2026]

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Disclaimer: This document is provided as a standardized framework. Consult qualified legal counsel for jurisdiction-specific statutory compliance.