Service Agreement to be reviewed by nurse Subscribe 1. PartiesThis Service Agreement is between Participant and All Aspects Nursing (Provider)Participant DetailsNameDate of BirthAddress Line 1Address Line 2CityStatePostcodeEmailPhoneParticipant FundingFunding Type: NDISNDIS No.NDIS Plan Start DateNDIS Plan End DateEmail of the Person signing the AgreementFunding Type: DSOADSOA National IDDSOA Plan Start DateDSOA Plan End DateEmail of the Person signing the AgreementParticipant’s Advocate / Representative / Legal Guardian details (such as a family member or friend)NameEmailPhoneRelationship to ParticipantPlan Management DetailsSupport Coordinator DetailsPlan Manager OrganisationPlan Manager NamePlan Manager PhonePlan Manager EmailSupport Coordinator OrganisationSupport Coordinator NameSupport Coordiator PhoneSupport Coordinator EmailandProvider Details Name: Perth Disability Care Pty LtdABN: 89 651 128 380Phone: 0479 041 048Email: info@perthdisabilitycare.com.auAgreement Start DateAgreement Start DateAgreement End DateAgreement End DateIn the event the NDIS Plan end date is changed, this Agreement will terminate on the new end date. A change to a plan end date typically results from an early plan review or a plan extension by NDIA. If a NDIS plan funding is ‘rolled over’ this service agreement stays in effect to align with the new end date of the NDIS Plan.NDIS Plan Management TypeSELF MANAGEDYou pay Perth Disability Care using your funding. All Aspects Nursing will send you an invoice after the service is completed. Please provide details of where to send the invoice. You need to pay the invoice within seven (7) days of receiving the invoice.PLAN MANAGEDAn organisation you have chosen can look after your funding money for you. NDIS will send your funding to this person or organisation. They will receive an invoice after the service is completed from Perth Disability Care. Please provide details of where to send the invoice. They need to pay the invoice within seven (7) days.AGENCY / NDIA MANAGEDNDIS will pay Perth Disability Care directly, using your funding money. Perth Disability Care will set up a service booking. Perth Disability Care will make sure you know: How much money Perth Disability Care has received. How the money is being used. How your budget is going. Schedule of Support Schedule of Support ID Code Description Unit Price Qty Line total Services TotalNon face to face supports by RN/CN will be charged as per applicable line-item rate.SignaturesThe parties agree to the terms and conditions of this Service Agreement. I acknowledge that the SA has been explained. Signature of authorised person from Perth Disability Care Representative Name of authorised person from Perth Disability Care RepresentativeDateSend Service Agreement to sign
