Dpc Patient Agreement

17. Full agreement. This agreement contains the entire agreement between the parties and replaces all previous written and written agreements and agreements concerning the purpose of this agreement. 4. Fee. In exchange for the services described above, the patient agrees to pay Frontier DPC, the amount covered by Schedule 1. This fee is payable at the time of the performance of this contract and is paid for services provided to the patient during the duration of the contract. If this agreement is terminated by one of the parties prior to the termination date of the contract, Frontier DPC reimburses the patient`s share in the initial payment, which remains after deducting individual fees for services provided to the patient until termination. 3. The physician acknowledges that he will not perform this contract at a time when the patient is in an emergency or urgent health situation. Fees are based on the age of patients ($39 per month for children, $69 per month for adults under 50, $84 for adults 50-64 and $109 per month for adults over 65), with discounts for businesses and other situations, as the doctor has established.

10% discount is offered for one-year payment in full or payment by ACH bank withdrawals rather than credit card. The purpose of this contract is to allow the patient (who is also a beneficiary of Medicare) and the physician to use this new provision in the Medicare Act and to define the rights and obligations of each law. This agreement is limited to the financial agreement between the doctor and the patient and is not intended to require a derpartei to take a certain duration of treatment. 4. Non-participation in insurance. The patient recognizes that neither Gulf Coast Direct Direct Primary Care nor the physician participates in health insurance or HMO plans. Neither the doctor nor the company ensures that the fees paid under this contract are covered by your health insurance or any other third-party payment plan that applies to the patient. The patient retains full and total responsibility for this provision. 4a. No participation in Medicare.

Neither Dr. Bernard nor Dr. Bakker participates in Medicare at Gulf Coast Direct Primary Care. Dr. Bernard can see Medicare patients in practice if they choose to pay their membership outside of the Medicare rebate, based on the “opt-out” provision of Medicare given by Dr. Bernard Medicare effective October 1, 2016. In this case, neither the doctor nor the patient must charge Medicare for the benefits provided by the Physician/Gulf Coast Direct Primary Care. Medicare patients can continue to use Medicare for all services outside of services provided directly by Dr. Bernard and Gulf Coast Direct Primary Care, such as prescription drugs, laboratory tests, diagnostic imaging, long-life medical equipment, medical specialists, etc. as Medicare allows. Since Dr. Bakker Medicare has not yet submitted an insurance under oath, she currently does not see any patients with the right to medicare.

1. Definitions: patient. A patient is defined as the person for whom the physician is required to provide services and who is a signatory to this agreement or who appears in the documents attached to Schedule 1 and is included by reference. Services. As noted in this agreement, the term services mean a set of services, both medical and non-medical, and certain amenities (a “service package”), provided by Gulf Coast Direct Primary Care, and presented in Schedule 1.