Required Family Consents
One signed bundle. Total clarity.
Before a participant attends their first day, a parent, spouse, adult child, guardian, or Power of Attorney must complete this consent bundle. This protects your loved one, our staff, and every other family in the building.
Mandatory Non-Medical Acknowledgment
We are a non-medical social adult day care.
Boca Raton Adult Day Care Center provides supervision, structured activity, meals, socialization, and caregiver respite in a non-medical setting. We do NOT provide: skilled nursing, IV therapy, injections, wound care, ventilator care, dialysis, psychiatric stabilization, controlled-substance administration, hospital-level monitoring, or any service that requires home-health or skilled-nursing licensure. For any medical emergency, our staff calls 911 first and notifies the listed emergency contact second. The Geriatric Wellness Clinic (Program C) is a separate, scheduled, secondary outpatient service — it is not on-call urgent care.
What's Inside the Bundle
Eight acknowledgments. One signature page.
1. Non-Medical Acknowledgment
You understand and accept the non-medical scope of Programs A and B and the secondary nature of Program C.
2. Assumption of Risk & Liability Waiver
Aging-related risks (falls, wandering, behavioral incidents, medical events) are inherent. You release the center and staff from liability arising from those inherent risks when reasonable care is provided.
3. Photo & Media Release
Optional. Permits use of participant photos in family updates, internal program records, social media, and marketing. Revocable in writing at any time.
4. Transportation Consent
Authorizes door-to-door transport within the 15-mile service radius. Acknowledges wheelchair securement procedures and route-time variability.
5. Telehealth Consent (Program C)
Acknowledges the limitations of virtual visits and that telehealth is never a substitute for emergency care.
6. Emergency Medical Authorization
Authorizes staff to call 911 and consent to emergency transport when the participant cannot consent and the emergency contact cannot be reached in time.
7. HIPAA Notice & Information Sharing
Acknowledges receipt of our Notice of Privacy Practices and authorizes coordination with named family, primary care provider, hospice, and pharmacy.
8. Code-of-Conduct & Discharge Acknowledgment
Acknowledges grounds for discharge: unsafe behavior, repeated late pickup, fraud, abusive conduct toward staff, or care needs exceeding our non-medical scope.
Signed Consent Bundle
Complete & submit — one per participant
Typed full legal name in the signature field constitutes an electronic signature under the Florida Electronic Signature Act and ESIGN. A countersigned PDF will be emailed back to you for your records.
A signed PDF will be emailed to the signer and stored in the participant's enrollment file. Questions? Email PFAdultDayCareCenter@gmail.com or call the center.