E bilanz elster online4/5/2023 ![]() ![]() ![]() The Department may notprovide legal advice to an Assisted Living Home.Assisted Living Home InformationName:Physical Address:Mailing Address:Assisted Living Home phone number :Resident Information:Name:Name of Resident’s Representative (if any)Representative’s phone numberThis agreement is made and entered into by and between (hereinafter “theHome”) and (hereinafter “Resident”) on thisday of, 20. EachAssisted Living Home is encouraged to retain independent legal counsel forpurposes of developing a Residential Services Contract. The Department makes no representationas to legal sufficiency or adequacy of this document under Alaska law. STATE OF ALASKADEPARTMENT OF HEALTH AND SOCIAL SERVICESDivision of Health Care ServicesResidential LicensingSample Residential Services Contract(Do not Use)Disclaimer: This is a sample Residential Services Contract intended only to outlinethe basic requirements of AS 47.33.210. ![]()
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