Terms of service

Patient Agreement
Integrity Medicine, LLC

This is an Agreement entered into today, between you (You, Your, the Patient), and Integrity Medicine, a Kansas Limited Liability Company (We, Us, the Clinic).

Background

Integrity Medicine is a Direct Primary Care medical practice, located at 715 Medical Center Drive, Suite 200, Newton, KS 67114. We do not take or accept insurance payments for providing medical care to You. Instead, We provide comprehensive primary care for a flat, monthly fee and other services based on our published prices. If You decide to seek care with Us, You agree to pay.

Definitions

1. Patient. In this Agreement, You are the Patient. We will provide You with medical care.
2. Services. The Services that We offer to You as part of this Agreement are listed in Appendix A.1.

Agreement

3. Notice: This Agreement is not medical insurance. The medical care that We offer, and Your membership with Us, does not meet the minimum requirements of the Affordable Care Act (“Obamacare”). In order to comply with the mandates of Obama-care, You will need to purchase a health insurance plan through a state or federal exchange.

4. Term. This Agreement will last for one year, starting today. Otherwise, the Agreement will automatically renew on the anniversary date. If either of us wants to cancel the Agreement, it can be canceled with 30 days written notice.

5. Payment. In exchange for our Services (see Appendix A.1), You agree to pay Us a monthly membership fee (see Appendix C). Your first payment is due the day that You sign this Agreement. After that, the fee is due on the first day of each following month. In order to keep our costs (and Your fee) low, Your fee will be paid automatically by debit card, credit card, or bank draft. If this Agreement is canceled by either of us before the end of the Agreement anniversary, We will review Your account and settle it by either refunding the unused part of Your membership fees (minus any outstanding balance) or by collecting any outstanding balance by charging Your debit card, credit card, or bank draft.

6. Medicare. In order to keep Our costs, and Your membership fees low, We do not participate in Medicare. Medicare cannot be billed for any of the Services that We provide. If You have Medicare or become eligible for Medicare, You will need to sign the Appendix D now and every two years, as required by law.


7. This is not Health Insurance. This Agreement is not medical insurance. This Agreement does not replace health insurance. This Agreement does not cover any Services not offered or provided by Us.

8. Communication. In order to provide fast and convenient care, We communicate with You by e-mail, fax (facsimile), video chat, cell phone, texting, and other electronic methods. Although We comply with HIPAA privacy requirements, these forms of communication cannot be guaranteed secure or confidential. There is always a risk that someone else can intercept and read texts and e-mails (eg., the NSA, FBI, hackers, family members, etc). Your signature means that You understand that We can’t guarantee the confidentiality of electronic communication with Us. By giving Us Your phone number and e-mail, You are authorizing Us to communicate with You by text
and e-mail. We will be discussing Your “protected health information” with You by text and e-mail. Those texts and emails may become a part of Your medical record.

9. Contacting Us. For routine, or non-urgent matters, please e-mail Us. We’ll get back to You as soon as possible, but within three days. For urgent matters, please text Us. We’ll get back to You as soon as possible, but within 24 hours. For possible emergencies, time-sensitive problems, or to discuss sensitive information, please call Us. In an emergency – when life, limb, or eyesight are in immediate
danger – call 911 or go to the nearest Emergency Room. If You are unsure if You are facing an emergency, use Your best judgment; You may also call Us for advice about how to handle the situation. If You do not receive a response from Us, in the time expected, contact Us a different way. Sometimes there are technical issues (text doesn’t work, email servers go offline or are under maintenance, etc).
We can’t anticipate every technical issue or plan for every situation. If You’re not getting a response, contact Us a different way.

10. Out of Office. Doctors are people too, and sometimes We need time away – due to illness, for vacations, to take care of our families, and for short-term missions. If We are planning to take time away, We’ll let You know beforehand – typically by e-mail. For unplanned time away, We’ll first try to coordinate within our Clinic to provide any Services that are time-sensitive. If We can’t help You, We’ll
direct You to the closest appropriate person who can help You. If You have to be see by a doctor outside of Our Clinic, Your care won’t be covered by this Agreement. But You can submit that fee to Your health insurance plan.

11. Miscellaneous. If there are new laws or changes to laws relevant to this Agreement, everyone agrees to amend this Agreement to comply with the laws. If any part of this Agreement is made legally invalid, the rest of it will remain as agreed. If the laws change, and We have to refund Your membership fees to You, You agree to pay Us the fair market value for the Services You received. You cannot transfer this Agreement to anyone else. Written notice is official if sent by first class, U.S. mail to the address in this Agreement.

What is written in this Agreement is the whole Agreement. This Agreement is a legal document. By signing this Agreement, You are saying that You have had time to get legal advice about this Agreement and either have gotten advice or not, but You agree with the Agreement. Any changes to this Agreement have to be made in writing and signed by all parties. If there are disagreements about this Agreement that can’t be resolved, the court in Netwon, Kansas has jurisdiction over the disagreement.