Capaz Service Agreement

Purpose of Agreement

This Service Agreement is made for the purpose of providing Supports under the Participant’s National Disability Insurance Scheme (NDIS) plan. A Support is a service, product, or equipment provided by the Provider under this agreement. A copy of the Participant’s NDIS plan is attached to this Service Agreement. The Parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to:

1. support the independence and social and economic participation of people with disability, and

2. enable people with a disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.

Supply of Supports

A supply of Supports under this Service Agreement is a supply of one or more reasonable and necessary supports specified in the statement of supports included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS Plan currently in effect under section 37 of the NDIS Act.

Start Date:			End Date:
Cost of the Services to be Provided (as per the NDIS Price Guide)
NDIS item number	Service to be provided	Item Price	Hours	Cost
15_005_0118_1_3	Therapeutic supports May include: - Face to face sessions - Parenting sessions	$193.99	20	$3879.80
15_005_0118_1_3	Therapeutic support Includes: - Initial Support planning - Report writing if required - Case conferencing - Resource Development	$193.99	5	$969.95
Services to be delivered fortnightly. The participant and practitioner can discuss changes as they see fit.		TOTALS 25		$4849.75

Responsibilities of the Participant/Participant's Representative

Participant/Participant's Representative agrees to:

1. Be responsible for ensuring that Supports purchased under this agreement falls within the guidelines of the Participant’s plan.

2. Ensure there are sufficient funds in the Participant’s budget to purchase the Supports requested.

3. Treat the Capaz staff with courtesy and respect.

4. Keep Capaz informed of any changes in personal circumstances that may affect the delivery of Supports.

5. Communicate with Capaz in a timely manner if the Participant has any concerns about the Supports being provided.

6. Where the Support item requires an appointment with Capaz, that the Participant gives 24 hours notice before cancelling any booked appointments.

7. Give Capaz the required notice if the Participant seeks to end the Service Agreement; and

8. Let the Capaz know immediately if the Participant’s NDIS plan is suspended or replaced, or the Participant stops being a qualified Participant in the NDIS.

Responsibilities of Capaz

Capaz agrees to:

1. Provide all supports under this agreement as outlined in Clause 3, in a manner that is timely and meets the participant's needs.

2. Communicate clearly, openly, and honestly.

3. Treat the Participant and any of the Participant’s representatives with courtesy and respect.

4. Consult the Participant on decisions regarding how Supports are provided.

5. Give the Participant information about managing any complaints or disagreements if required.

6. Listen to the participant's feedback and resolve problems quickly.

7. Protect the Participant’s privacy and confidential information.

8. Advise the Participant of any delays in the delivery of Supports.

9. Provide Supports in a manner consistent with all relevant laws, including but not limited to the National Disability Insurance Scheme Act 2013 its associated rules and regulations as issued and amended from time to time, and the Australian Consumer Law; and

10. Keep accurate records on the Supports provided to the Participant

Cancelling/Rescheduling a Scheduled Appointment

I agree to provide Capaz with a minimum 24hours notice if needing to cancel a scheduled support. Failure to do so will result in the appointment being charged against my NDIS plan.

Ending this Service Agreement

Should you wish to end this Service agreement you can do so by letting Capaz know. The Service can be terminated immediately if you wish. If this Service decides to end the agreement, Capaz will give you 2 weeks’ notice and where appropriate support you to find another service provider. If either party seriously breaches this Service Agreement the notice period will not apply.

Changes to this Service Agreement

If changes to the supports or delivery are required, the parties agree to discuss and review this Service Agreement. The parties agree that any changes to this Service Agreement will be in writing, signed and dated by the parties.

Change or Take Away Consent

If you want to change or take away consent at any time, please contact us by phoning 0427 145 001 or email [email protected]

This includes if you want to:

• Change who has consent

• Change how long you want consent to last 

• Change what types of consent you’ve given  

• Take away consent and do things by yourself

If you choose to change or take away consent, Capaz Health will not rely on your past consent for any future use or disclosure of your personal information.

Payments

The participant has nominated to self-manage/have their plan managed as part of their NDIS funding. Capaz will invoice the participant/their plan manager directly. Invoices or itemised account of services provided are available upon your request.

Feedback, Complaints and disputes

If any reason you have questions or are not happy with the service, please contact Sarah Shuter at [email protected] or on 0427 145 001 or Po Box 215, Port Macquarie, NSW 2444. If you feel you need extra support to have your say, you or your support person can contact NDIA 1800 800 110 or visit www.ndis.gov.au.