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Doctor Patient Agreement Template for United States

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Key Requirements PROMPT example:

Doctor Patient Agreement

"I need a Doctor Patient Agreement for my small family practice in California, which includes specific provisions for telehealth services and a comprehensive fee schedule for both in-person and virtual consultations starting January 2025."

Document background
The Doctor Patient Agreement serves as the foundational document governing the relationship between healthcare providers and patients in the United States. This agreement is essential for establishing clear expectations, ensuring HIPAA compliance, and protecting both parties' rights and interests. It typically includes provisions for consent to treatment, financial responsibilities, privacy protections, and terms for ongoing care. The agreement should be customized to comply with specific state medical practice acts while maintaining consistency with federal healthcare regulations. Healthcare providers commonly implement this agreement at the initiation of care to ensure transparent communication and legal protection.
Suggested Sections

1. Parties: Identifies the healthcare provider and patient with full legal names and addresses

2. Background: Establishes the context of the medical relationship and basic premises of care

3. Definitions: Defines key terms used throughout the agreement including medical terminology and legal terms

4. Scope of Services: Outlines the medical services to be provided and any limitations

5. Patient Rights and Responsibilities: Details the rights of the patient and their obligations in the medical relationship

6. Privacy and HIPAA Compliance: Explains how patient information will be handled and protected under HIPAA regulations

7. Financial Terms: Details payment terms, insurance requirements, and billing procedures

8. Term and Termination: Specifies duration of agreement and conditions for ending the doctor-patient relationship

Optional Sections

1. Telemedicine Services: Terms and conditions for virtual medical consultations and remote healthcare services

2. Specialized Treatment Provisions: Specific terms and conditions for particular treatments or specialized medical procedures

3. Research Participation: Terms governing patient participation in medical research and clinical trials

4. Third-Party Services: Terms regarding referrals, external service providers, and coordination of care

Suggested Schedules

1. Schedule A - Fee Schedule: Detailed listing of service fees and charges for medical services

2. Schedule B - HIPAA Authorization Form: Standard HIPAA compliance documentation and privacy authorizations

3. Schedule C - Informed Consent Forms: Standard and specific consent forms for procedures or treatments

4. Schedule D - Practice Policies: Detailed office policies, procedures, and operational guidelines

5. Schedule E - Emergency Contact Form: Patient emergency contact details and emergency care preferences

6. Schedule F - Insurance Information Form: Patient insurance details, coverage information, and billing preferences

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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Industries

HIPAA Compliance: Health Insurance Portability and Accountability Act requirements for patient privacy, security of health information, and patient rights regarding their medical data

ADA Requirements: Americans with Disabilities Act provisions ensuring accessible medical services and reasonable accommodations for patients with disabilities

ACA Considerations: Patient Protection and Affordable Care Act requirements regarding patient care, insurance coverage, and non-discrimination

Anti-Kickback Statute: Federal law prohibiting the exchange of anything of value to reward or induce patient referrals covered by federal healthcare programs

Stark Law: Physician self-referral law regulations governing financial relationships and referrals

EMTALA Compliance: Emergency Medical Treatment and Active Labor Act requirements for emergency medical treatment regardless of ability to pay

State Medical Practice Acts: State-specific regulations governing medical practice, licensing requirements, and standard of care

State Privacy Laws: Additional state-specific patient privacy protections that may exceed federal HIPAA requirements

Informed Consent Requirements: State-specific rules for obtaining and documenting patient consent for medical procedures and treatments

Medical Records Retention: State-specific requirements for maintaining and storing patient medical records

State Malpractice Laws: State-specific medical malpractice regulations and liability requirements

Medical Board Regulations: State Medical Board requirements for professional conduct and practice standards

Professional Guidelines: Medical association guidelines and professional standards for patient care and practice management

Medical Ethics: Ethical guidelines and principles for medical practice and patient care

Documentation Standards: Requirements for maintaining accurate and complete medical records and documentation

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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