A 2-page Word rate sheet for a non-medical home care agency to show clients its hourly rates and what each care level includes.

For USA home care agency owners and intake staff. Plus 1 agency instructions page to remove before use.

What’s included

1. Page 1: rates effective date, service area, license number space, and the rate table by care level (weekday and weekend rates) with terms
2. Page 2: what each care level includes (companion and personal care lists)
3. Agency instructions page, to remove before use

Add your logo and name

1. Open the Word file and replace the Your Logo Here box with your logo.
2. Replace Agency Name in the letterhead; the body says “the Agency,” so no other name edits are needed.
3. Replace the Street Address, City, State ZIP line and the Phone, Email, Website line with your details.
4. Fill in your own rates. Set the letterhead text to black, delete the instructions page, and save.

Customizable template, not legal advice; check your state’s requirements. Not a license to operate, not HIPAA software, and no medical claims. Rates are yours to set; the sheet does not promise any insurer or program will pay.