Nevada · Personal care agencies
Nevada Starter Forms Pack
Five editable forms a new Nevada non-medical home care agency needs for client files and caregiver records, organized around the state's personal care agency regulations (NAC 449.396 to 449.3982).
Current as of October 20, 2026. Reflects Nevada's 2025 move of personal care agency law to NRS chapter 449B.
What's included
| File (.docx + .pdf) | What it covers |
|---|---|
| 01 Client Intake Form 3 pages | Client and representative info, emergency and care contacts, services requested (bathing, dressing, meals, laundry, transportation and more), special needs, home environment, and a screening-review checklist tied to NAC 449.3981(3). |
| 02 Client Service Agreement 3 pages | Sections for each written disclosure item in NAC 449.3979(2): scope statement, caregiver qualifications, charges, billing and price-change notice, missed visits, on-call contact, termination, client rights and grievances, the NRS 449B.260 nondiscrimination statement, and signed acknowledgments. |
| 03 Caregiver Timesheet 1 page | Weekly log of visits with time in and out, hours, task codes, client initials, notes, and caregiver, client and supervisor signatures. |
| 04 Incident Report 3 pages | Incident type checklist, factual description, immediate actions, notification log, witnesses, administrator investigation, corrective actions, and client follow-up. |
| 05 Caregiver Training Log 2 pages | Hire and first-care dates, a tracker for recurring Nevada training requirements with citations, a session log with the fields NAC 449.3976(2) lists, and a competency sign-off. |
- Word (.docx) versions open in Microsoft Word, Google Docs, Apple Pages, or LibreOffice.
- Matching print-ready PDFs.
- Bracketed placeholders for your agency name, address, phone, and license number.
- Each page footer: "Template - review before use, not legal advice" and "Current as of October 20, 2026".
- A "Start Here" file explaining how to customize and where to check the official rules.
Sample pages
First page of each form, shown with a "SAMPLE" watermark.
Nevada Starter Forms Pack
$29
- Secure checkout by Stripe (we never see your card)
- Download link emailed right away (valid 7 days, 5 downloads)
- 14-day refund if the files don't match this description
Full Nevada Kit
$249 for the full kit, or $299 with 1 year of updates. Join the waitlist to hear when it's ready.
Free Nevada guides
How to start a home care agency in Nevada
The step-by-step roadmap from forming your business to your first client.
License requirements
Administrator, staff, training, background checks, bond, insurance, and renewal.
Application checklist
Each document the state asks you to upload, and what it must show.
Get the free 2-page licensing checklist (PDF)
Important: Templates only. Not legal advice. Not affiliated with any state agency. No guarantee of license approval. Using these templates does not by itself make an agency compliant with Nevada law. Confirm current requirements with the Health Care Purchasing and Compliance Division of the Nevada Health Authority before you file.