AJ Primary Health Care Agreement

Welcome  About us  Coverage  Laboratory  Radiology  Agreement  Enroll  Contact

Background

   The office, who specializes in family medicine, delivers care on behalf of Javier Garcia DNP Medical Office, located at 855 East 10TH Ave. Hialeah, FL 33010.  This medical plan is an agreement between the office and patient, who will be treated at the office for a regular monthly payment. Healthcare providers can be MD, NP or PA.

Agreement.

Definitions

  1. A patient is defined as those persons for whom the health care provider shall provide services, and who are signatories to, or listed on the documents attached as Appendix 1, and incorporated by reference to this agreement.
  2. As used in the agreement, the term services, shall mean a package of services, both medical and non-medical, and certain amenities (collectively “Services”), which are offered by Javier Garcia Asencio DNP Medical Office, Inc, and set forth in Appendix 1.
  3. This agreement shall commence on the date signed by the parties and shall continue for a period of one month, automatically renewed.
  4. In exchange for the services described herein, patient agrees to pay Javier Garcia DNP Medical Office, Inc the amount as set forth in Appendix 1, attached. This fee is payable upon execution of this agreement and is in payment for the services provided to patient during the term of this agreement. If this agreement is cancelled by either party before the agreement termination date, then Javier Garcia DNP Medical Office, Inc shall refund the patient’s prorated share of the original payment remaining after deducting individual charges for services rendered to patient up to cancellation.
  5. Non-participation in Insurance. Patient acknowledges that neither Javier Garcia DNP Medical Office, Inc, nor the provider, participate in any health insurance or HMO plans or panels and has opted out of Medicare under this agreement. Neither of the above make any representations whatsoever that any fees paid under this agreement are covered by your health insurance or other third-party payment plans applicable to the Patient. The Patient shall retain full and complete responsibility for any such determination. If the Patient, during the term of this Agreement becomes eligible for Medicare or any other health plan, then patient will cancel this agreement and will start service under the new insurance. Patient is aware that no guarantee that he will maintain the same provider or neither Javier Garcia DNP medical office, Inc. Medicare/Medicaid/HMO or any other insurance cannot be billed for any services performed for you by the provider. You agree not to bill Medicare/Medicaid/HMO or any other insurance or attempt reimbursement for any such services. Patient shall renew and sign the agreement in Appendix 1 every two years.
  6. Insurance or Other Medical Coverage. Patient acknowledges and understands that this agreement is not an insurance plan, and not a substitute for health insurance or other health plan coverage (such as membership in an HMO). It will not cover hospital services, or any services not personally provided by Javier Garcia DNP Medical Office, Inc. Patient acknowledges that Javier Garcia DNP Medical Office, Inc has advised that patient obtain or keep in full force such health insurance policy(s) or plans that will cover patient for general healthcare costs. Patient acknowledges that this agreement is not a contract that provides health insurance, and this Agreement is not intended to replace any existing or future health insurance or health plan coverage that Patient may carry.
  7. Termination. This Agreement will commence on the date first written in Appendix 1 and will extend monthly thereafter. Notwithstanding the above, both patient and Javier Garcia DNP Medical Office, Inc shall have the absolute and unconditional right to terminate the agreement, without the showing of any cause for termination, upon giving 30 days prior written notice to the other party. Unless previously terminated as set forth above, at the expiration of the initial one-month term (and each succeeding monthly term), the agreement will automatically renew for successive monthly terms upon the payment of the monthly fee at the start of the contract month. It is the responsibility of patient guarantee the monthly payment in order to receive services. Payment due will cancel the agreement automatically and patient will not receive services and new contract will be needed to start services.
  8. Patient acknowledges that communications with the health care provider using e-mail, facsimile (fax), video chat, instant messaging, and cell phone are not guaranteed to be secure or confidential methods of communications. As such, Patient expressly waives the provider’s obligation to guarantee confidentiality with respect to correspondence using such means of communication. Patient acknowledges that all such communications may become a part of your medical records. By providing Patient’s email address on the attached Appendix 1, Patient authorizes Javier Garcia DNP medical Office and its providers to communicate with patient by email regarding Patient’s “protected health information” (PHI) (as that term is defined in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and it’s implementing regulations). By inserting Patient’s email address in Appendix 1, Patient acknowledges that:
    • a) Email is not a secure medium for sending or receiving PHI and there is always a possibility that a third party may gain access;
    • b) Although the provider will make all reasonable efforts to keep email communications confidential and secure, neither Javier Garcia DNP Medical Office, Inc, nor the provider, can ensure or guarantee the absolute confidentiality of email communications;
    • c) Email communications may be made a part of patient’s permanent medical record;
    • d) Patient understands and agrees that email is not an appropriate means of communication regarding emergency or other time-sensitive issues or for inquiries regarding sensitive information. In the event of an emergency, or a situation which could be reasonably expected to develop into an Emergency, the Patient shall call 911 or the nearest Emergency room and follow the directions of the emergency personnel. If the patient does not receive a response to an email message within one day, Patient agrees to use another means of communication to contact the provider. Neither Javier Garcia DNP Medical Office, Inc nor the provider will be liable to patient for any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to patient as a result of technical failures, including, but not limited to technical failures attributable to any internet service provider, power outages, failures of any electronic message software, or failure to properly address email messages, failure of the Practice’s computers or computer network, or faulty telephone or cable data transmission, any interception of email communications by a third party, or Patient’s failure to comply with the guidelines regarding use of email communications set forth in this paragraph.
  9. Change of Law. If there is a change of any law, regulation or rule, federal, state, or local, which affects the agreement including these Terms & Conditions, which are incorporated by reference in the agreement, or the activities of either party under the agreement, or any change in judicial or administrative interpretation of any such law, regulation or rule, and either party reasonably believes in good faith that the change will have a substantial adverse effect on that party’s rights, obligations, or operations associated with this agreement, then that party may, upon written notice, require the other party to enter into good faith negotiations to renegotiate the terms of the agreement including these Terms & Conditions. If the parties are unable to reach an agreement concerning the modification of the agreement within forty-five days after the effective date of change, then either party may immediately terminate the agreement by written notice to the other party.
  10. If for any reason any provision of this agreement shall be deemed, by a court of competent jurisdiction, to be legally invalid or unenforceable in any jurisdiction to which it applies, the validity of the remainder of the agreement shall not be affected, and that provision shall be deemed modified to the minimum extent necessary to make that provision consistent with applicable law and in its modified form that provision shall then be enforceable.
  11. Reimbursement for services rendered. If this agreement is held to be invalid for any reason, and if Javier Garcia DNP Medical Office, Inc is therefore required to refund all or any portion of the monthly fees paid by patient, patient agrees to pay Javier Garcia DNP Medical Office, Inc an amount equal to the reasonable value of services actually rendered to patient during the period of time for which the refunded fees were paid.
  12. No amendment of this agreement shall be binding of a party unless it is made in writing and signed by all the parties. Notwithstanding the foregoing, the provider may unilaterally amend this agreement to the extent required by federal, state, or local law or regulation (“Applicable Law”) by sending patient 30 days written advance notice of any such change. Any such changes are incorporated by reference into this agreement without the need for signature by the parties and are effective as of the date established by Javier Garcia DNP Medical Office, Inc, except that patient shall initial any such change at Javier Garcia DNP Medical Office, Inc request. Moreover, if applicable law requires this agreement to contain provisions that are not expressly set forth in this agreement, then, to the extent necessary, such provisions shall be incorporated by reference into this agreement and shall be deemed a part of this agreement as though they had been expressly set forth in this agreement.
  13. This agreement, and any rights the patient may have under it, may not be assigned or transferred by patient.
  14. Relationship of Parties. Patient and the provider intend and agree that the provider, in performing her duties under this agreement, is an independent contractor, as defined by the guidelines promulgated by the United States Internal Revenue Service and/or the United States Department of Labor, and the provider shall have exclusive control of his work and the manner in which it is performed.
  15. Legal Significance. Patient acknowledges that this agreement is a legal document and creates certain rights and responsibilities. Patient also acknowledges having had a reasonable time to seek legal advice regarding the agreement and has either chosen not to do so or has done so and is satisfied with the terms and conditions of the agreement.
  16. This agreement shall be construed without regard to any presumptions or rules requiring construction against the party causing the instrument to be drafted. Captions in this agreement are used for convenience only and shall not limit, broaden, or qualify the text.
  17. Entire Agreement. This agreement contains the entire agreement between the parties and supersedes all prior oral and written understandings and agreements regarding the subject matter of this agreement.
  18. This Agreement shall be governed and construed under the laws of the State of Florida and all disputes arising out of this agreement shall be settled in the court of proper venue and jurisdiction for Javier Garcia DNP Medical Office, Inc address in Hialeah, FL.
  19. All written notices are deemed served if sent to the address of the party written in Appendix 1 by first class U.S. mail. The parties have signed duplicate counterparts of this Agreement on the date first written.

Appendix 1

SERVICES AND PAYMENT TERMS

  1. Medical Services. As used in this agreement, the term services shall mean those medical services that the provider is permitted to perform under the laws of the State of Florida and that are consistent with the provider’s training and experience as a family medicine provider.
  2. Non-Medical, Personalized Services. Javier Garcia DNP Medical Office, Inc shall provide patient with the following Non-Medical Services:
    • a) 24/7 Access. Patient shall have access to the provider via text messaging, email, video chat, and cell phone on a 24 hour per day, 7 day per week basis. It will be understood that communications outside of regularly scheduled business hours should be made for urgent issues and routine issues should be held until regularly scheduled business hours resume. Patient shall be given a phone number where patient may reach the provider directly around the clock. The provider may from time to time, due to vacation, sick days, and other similar situations, not be available to provide the services referred to above in paragraph 1. During such times, Patient’s calls to the provider, or to the provider’s office, will be directed to a provider who is “covering” for the provider during his/her absence. In an unforeseen situation where the provider is unavailable emergently, Javier Garcia DNP Medical Office, Inc will make every effort to arrange for coverage but cannot guarantee such coverage.
    • b) Email Access. Patient shall be given the provider’s email address to which nonurgent communications can be addressed. Such communications shall be dealt with by the provider in a timely manner. Patient understands and agrees that email and the internet should never be used to access medical care in the event of an urgent or emergent situation or any situation that Patient could reasonably expect may develop into an emergency. Patient agrees that in such situations, when a Patient cannot speak to provider immediately in person or by telephone, that Patient shall call 911 or the nearest emergency medical assistance provider and follow the directions of the emergency provider.
    • c) No wait or minimal wait appointments. Every effort shall be made to assure that patient is seen by the provider immediately upon arrival for a scheduled office visit or after only a minimal wait. If provider foresees a minimal wait time, patient shall be contacted and advised of the projected wait time.
    • d) Same Day/Next Day Appointments. When patient calls or emails the provider prior to noon on a normal office day (Monday through Friday) to schedule an appointment, every reasonable effort shall be made to schedule an appointment with the provider on the same day. If the patient calls or emails the provider after noon on a normal office day (Monday through Friday) to schedule an appointment, every reasonable effort shall be made to schedule Patient’s appointment with provider on the same or following normal office day.
    • e) Home or Office Visits. Patient may request that the provider see patient in patient’s home or office, and in situations where the provider considers such a visit reasonably necessary and appropriate, the provider will make every reasonable effort to comply with Patient’s request. If Patient expects all visits (including routine and wellness visits) will be required to be made as Home Visits by the provider, Patient will select the “Home Visit” Payment Plan.
    • f) Visitors temporarily visiting a patient from out of town may, for a two-week period, take advantage of the services described in (a), (c), and (d) of this Appendix on a fee-for-service basis and as availability with the provider reasonably allows. Visitors who are Medicare Beneficiaries must be covered by a Medicare opt-out and waiver agreement in order to be treated by Javier Garcia DNP Medical Office, Inc.
    • g) JAVIER GARCIA DNP MEDICAL OFFICE, INC shall coordinate with medical specialists to whom patient is referred to assist patient in obtaining specialty care. Patient understands that fees paid under this agreement do not include and do not cover specialists’ fees or fees due to any medical professional other than JAVIER GARCIA DNP MEDICAL OFFICE INC.
    • h) Health Care providers. Patient is aware that service will be provided by a health care provider, who is authorized to practice by the State of Florida and performing within the scope of their practice as defined by State law. It can be a Physician (Doctor of medicine or osteopathy) or Nurse Practitioner (Family-Adult).

Welcome  About us  Coverage  Laboratory  Radiology  Agreement  Enroll  Contact

 

mcafee

AJ Primary Health Care

2020