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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."
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
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
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
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