Direct Primary Care Agreement
This Agreement is entered into between NOVAKIND HEALTH (“Practice,” “We,” or “Us”) and ___________________________ (“Patient,” “Member,” or “You”).
A. Background
NOVAKIND HEALTH delivers primary care medicine to patients at 1760 Termino Ave, Long Beach, California 90804.
In exchange for periodic fees, the Practice agrees to provide the patient with the primary care services described in this Agreement, under the terms and conditions herein.
B. Definitions
Services: “Services” refers to the medical and non-medical services the Practice agrees to provide, as described in Appendix A (attached and incorporated by reference).
Patient/Member/You: Refers to the individual(s) for whom the Provider provides care and who has signed this Agreement.
Agreement Term: This Agreement lasts one year from the date it is fully executed by both parties. No practitioner-patient relationship is formed until the Agreement is fully executed.
Renewal: The Agreement automatically renews each year unless either party provides 30 days’ written notice prior to the anniversary date.
Termination: Either party may terminate this Agreement at any time with 30 days’ written notice.
Payment: Membership fees and a one-time, non-refundable Enrollment Fee are due upon execution of this Agreement.
Monthly Membership Fees are due on the same day each month as indicated in the enrollment form.
Payments are made via automatic debit or credit card.
C. Refunds
If you cancel before the term ends, we will settle your account as follows: If the fair market value of the Services you received over the term of the Agreement exceeds the amount You paid in membership fees before early termination, You shall reimburse the Practice in an amount equal to the difference between the fair market value of the services received and the amount You paid in membership fees over the term of the Agreement. The Parties agree that the fair market value of the services is equal to the Practice’s cash-pay, fee-for-service charges. A copy of these fees is available on request.
D. Fee and Service Adjustments
In the event that the Practice finds it necessary to increase or adjust monthly fees or Service offerings before the termination of the Agreement, Practice shall give Patients 30 days written notice of any adjustment. If the Patient does not consent to the modification, the Patient may terminate the Agreement in writing prior to the next scheduled monthly payment.
E. Insurance Participation
Hybrid Model: The Practice accepts both DPC memberships and Insurance-Based Visits.
Direct Primary Care Only Patients: For patients not using insurance, the membership provides all-inclusive access to primary care as described in Appendix A. The Practice will not bill your insurance company if you are a DPC member.
Insurance Billing: For patients who do not participate in DPC membership, the Practice will submit bills directly to their insurance; standard copays and deductibles apply. Patients with government-funded insurance for example, Medicare and Medi-cal, cannot participate in NOVAKIND HEALTH’s DPC program. If you become eligible for MEDICARE you must notify the Practice and cancel your membership
F. This Agreement is Not Health Insurance
This Agreement does not provide health insurance coverage. It provides only the health care services specifically described in Appendix A. Any services or treatments not identified in Appendix A are specifically excluded. You understand that this Agreement does not replace any existing health insurance or health plan coverage that you may carry. You acknowledge that the Practice has advised You to obtain or keep in full force, health care coverage that will cover care and treatment not included in this Agreement, including, but not limited to, specialty care, outside testing, surgeries, and hospitalization.
G. Communications
The Practice endeavors to provide Patients with the convenience of a wide variety of electronic communication options. And although we are careful to comply with patient confidentiality requirements and make every attempt to protect your privacy, communications by email, facsimile, video chat, cell phone, texting, and other electronic means can never be absolutely guaranteed to be secure or confidential methods of communications. You agree that by participating in the above means of communication, you expressly waive any guarantee of absolute confidentiality with respect to their use. You further understand that participation in the above means of communication is not a condition of membership in this Practice and that you have the option to decline any particular means of communication.
H. Email and Text Usage.
By providing the Practice with an email address on the patient portal or the website scheduler, the Patient authorizes the Practice and its staff to communicate with him/her by email regarding the Patient’s “protected health information” (PHI). By providing a cell phone number on the online the patient portal or the website scheduler, Patient consents to text message communication containing PHI through the number provided. Patient further acknowledges that: Email and text message are not necessarily secure methods of sending or receiving PHI, and there is always a possibility that a third party may gain access; Although the Practice and its staff shall make all reasonable efforts to keep email and text communications confidential and secure, absolute confidentiality of these communications can never be guaranteed; You further understand that email and text messaging are not appropriate means of communication in an emergency or for dealing with time-sensitive issues. So, in an emergency or in a situation which could reasonably be expected to develop into an emergency, You understand and agree to call 911 or go to the nearest emergency treatment facility and follow the directions of emergency personnel.
I. Technical Failure
Neither the Practice nor Your Provider will be liable for any loss, injury, or expense arising from a delay in responding to the Patient when that delay is caused by technical failure. Examples of technical failures: (i) failures caused by an internet or cell phone service provider; (ii) power outages; (iii) failure of electronic messaging software or email provider; (iv) failure of the Practice’s computers or computer network, or faulty telephone or cable data transmission; (iv) any interception of email communications by a third party which is unauthorized by the Practice; or (v) Patient’s failure to comply with the guidelines for the use of email or text messaging, as described in this Agreement.
J. Provider Absence
From time to time, due to vacations, illness, or personal emergency, Your Provider may be temporarily unavailable to provide the services referred to in Appendix A. To assist Patients in scheduling non-urgent visits, the Practice will notify Patients of any planned provider absences as soon as the dates are confirmed.
K. Dispute Resolution
Each party agrees not to make any inaccurate or untrue and disparaging statements, oral, written, or electronic, about the other. We strive to deliver only the best of personalized patient care to every Member, but occasionally misunderstandings arise. We welcome sincere and open dialogue with our Members, especially if we fail to meet expectations. We are committed to resolving all Patient concerns. Therefore, in the event that You are dissatisfied with or have concerns about any staff member, service, treatment, or experience arising from Your membership in this Practice, You and the Practice agree to refrain from creating, posting or causing to be posted on the internet or social media, any untrue, unconfirmed, inaccurate, disparaging comments about the other. Rather, the Parties agree to engage in the following process:
1. The Patient shall first discuss any complaints concerns or issues with their Provider;
2. The Provider shall respond to each of the Patient’s issues and complaints;
3. If, after such response, the Patient remains dissatisfied, the Parties shall enter into discussion and attempt to reach a mutually acceptable solution.
L. Change of Law
If there is a change of any relevant law, regulation, or rule which affects the terms of this Agreement, the parties agree to amend this Agreement only to the extent necessary to comply with the law.
M. Severability
If any part of this Agreement is considered legally invalid or unenforceable by a court of competent jurisdiction, that part will be amended to the extent necessary to be enforceable, and the remainder of the Agreement will stay in force as originally written.
Reimbursement for Services Rendered
If this Agreement is held to be invalid for any reason, and the Practice is required to refund fees, You agree to pay the Practice an amount equal to the fair market value of the medical services You received during the time period for which the refunded fees were paid.
Amendment
Except as provided within, no amendment of this Agreement shall be binding on a party unless it is in writing and signed by all the parties.
Assignment
Neither this Agreement nor any rights provided under it may be assigned or transferred by the Patient to any other party.
Legal Significance
You acknowledge that this Agreement is a legal document and gives the parties certain rights and responsibilities. You also acknowledge that You have had a reasonable time to seek legal advice regarding the Agreement and have either chosen not to do so or have done so and are satisfied with the terms and conditions of the Agreement.
Miscellaneous
This Agreement shall be construed without regard to any rules requiring that it be construed against the party who drafted the Agreement. The captions in this Agreement are only for the sake of convenience and have no legal meaning.
Entire Agreement
This Agreement contains the entire Agreement between the parties and replaces any earlier understandings and agreements, whether they are written or oral.
No Waiver
To allow for the flexibility of certain terms of the Agreement, each party agrees that they may choose to delay or not to enforce the other party’s requirement or duty under this Agreement (for example, notice periods, payment terms, etc.). Doing so will not constitute a waiver of that duty or responsibility. The party will have the right to enforce such terms again at any time.
Jurisdiction
This Agreement shall be governed and construed under the laws of the State of California. All disputes arising out of this Agreement shall be settled in the court of proper venue and jurisdiction for the Practice in Long Beach, California.
Notice
Notice as required in paragraph 5 may be achieved by the Parties through f irst-class US Mail or electronically (by sending notice to the most recent email address provided by the party to be noticed). All other required notices must be sent through first-class US Mail, to the Practice at the address first written above and to the Patient at the address in the online enrollment.
Appendix A – Services
Medical Services
(As determined appropriate by the Physician)
Acute and Non-Acute Office Visits
Preventative care and annual wellness visits
Chronic Disease Management (Diabetes, Asthma, etc.)
Women’s Health and Well-Woman Care
Electrocardiogram (EKG)
Blood Pressure & Diabetic Monitoring
Spirometry, Pulse Oximeter, Breathing Treatments
Dipstick Urinalysis, Blood Glucose
Cryotherapy (warts), Cerumen Removal, Lavage
Follow-up Wound Care, Staple/Suture Removal
Men’s health services
Mental and emotional health resources
Patient is responsible for all costs, including supplies, products, drugs, laboratory testing, and specimen analysis, which are associated with the above services and procedures. Testing shall be available through selected vendors at cash-pay prices. Patient will be advised in advance of any such additional costs. Payment is due at time of service, and Patient always retains the right to receive services from another Provider or facility of choice.
Non-Medical, Personalized Services
After-Hours Access: Messages to care team, results, and prescription refills are available 24/7 through patient portal. Please visit an emergency or urgent care center for emergencies.
Email & Text Access: Secure, non-urgent communication with your care team.
No/Minimal Wait: Patients are seen promptly or notified of any delays.
Same-Day/Next-Day Appointments: When the Patient contacts the Practice prior to 10 AM on a regular office day (Monday through Thursday) with an urgent need, the Patient shall be scheduled for a visit on that same day. Or, if this is not possible, Patient shall be given an appointment for the next regular office day.
Specialist Coordination: The Provider shall coordinate with Patient’s medical specialists and refer Patient to the proper specialists if desired. Patient understands that this Agreement does not cover specialist’s fees or fees due to any medical professional other than the Practice staff. All charges for care received outside the Practice are the Patient’s responsibility.