The Financial Agreement For Medical Office is a crucial document used in Philippine healthcare settings to establish clear financial arrangements between medical providers and patients. This agreement is essential for medical practices operating under Philippine jurisdiction, particularly in light of the Universal Health Care Act and related healthcare regulations. It addresses key aspects including payment terms, insurance procedures, financial responsibilities, and compliance with local healthcare laws. The document is designed to protect both the healthcare provider's financial interests and patient rights, while ensuring compliance with Philippine healthcare facility regulations, data privacy laws, and consumer protection requirements. It's particularly relevant for private medical practices, clinics, and healthcare facilities that need to establish clear financial policies and payment procedures with their patients.
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1. Parties: Identification of the medical office/provider and the patient/guarantor
2. Background: Context of the agreement and relationship between parties
3. Definitions: Key terms used throughout the agreement
4. Services and Charges: Description of medical services covered and associated fee structure
5. Payment Terms: Payment schedules, methods, and conditions
6. Insurance and Claims: Procedures for insurance claims and coordination of benefits
7. Patient Responsibilities: Financial obligations and required patient cooperation
8. Provider Responsibilities: Medical office obligations and service commitments
9. Confidentiality and Data Protection: Handling of patient information under Data Privacy Act
10. Default and Remedies: Consequences of non-payment and available remedies
11. Term and Termination: Duration of agreement and termination conditions
12. General Provisions: Standard legal clauses including governing law and notices
1. Third-Party Guarantor: Used when someone other than the patient is financially responsible
2. Payment Plans: Include when offering installment payment options
3. Emergency Services: Required for facilities offering emergency care
4. Government Insurance Coverage: Include when PhilHealth or other government insurance is accepted
5. Charity Care Policy: Required for facilities offering indigent care programs
6. Medical Records Access: Detailed procedures for requesting and charging for medical records
7. Telehealth Services: Include if offering remote healthcare services
1. Schedule A - Fee Schedule: Detailed list of services and corresponding fees
2. Schedule B - Payment Plan Options: Available payment plans and their terms
3. Schedule C - Insurance Partners: List of accepted insurance providers and coverage terms
4. Appendix 1 - Patient Rights: Statement of patient rights under Philippine law
5. Appendix 2 - Privacy Policy: Detailed privacy practices and data protection procedures
6. Appendix 3 - Required Forms: Standard forms for insurance, consent, and financial responsibility
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