IF YOU HAVE A MEDICAL EMERGENCY, IMMEDIATELY CALL YOUR PRIMARY CARE PROVIDER OR DIAL 911.
Formal Agreement. These Medical Terms of Service (“Medical Terms of Service”) form a legal agreement between you and the medical providers accessed through Index Health. Those medical providers include but are not limited to Ziemba Medical P.C. and its providers (Collectively, “Index Clinic”, “our”, “we” or “us”).
Relation to Index Health. We are affiliated with Index Health, which provides us with administrative and management services. Index Health provides membership and certain non-medical services to its members. Please read the Index Health Membership Terms of Service prior to using Index Health.
Limitation of Services. The services offered by Index Clinic do not replace your relationship with any physician, in-person provider or your primary care provider.
Modification of Medical Terms of Service. We may, from time to time, change these Medical Terms of Service. Please check these Medical Terms of Service periodically for changes. Revisions will be effective immediately except that, for existing users, material revisions will be effective 30 days after posting or notice to you of the revisions unless otherwise stated. We may require that you accept modified Medical Terms of Service in order to continue to use our Medical Services. If you do not agree to the modified Medical Terms of Service, then you should discontinue your use of the Medical Services. Except as expressly permitted in this Section 4 (Modification of Medical Terms of Service), these Medical Terms of Service may be amended only by a written agreement signed by authorized representatives of the parties to these Medical Terms of Service.
Payment for Medical Service. By providing your health insurance or health plan information and or policy numbers, you are authorizing for us to submit claims for all eligible and covered Medical Services to your health insurer or health plan. You similarly are authorizing the payment of Medical Services from your health insurer or health plan to us. You permit, authorize and consent to our releasing any medical information, including those related to Medical Services rendered or diagnosis made, in order to process claims to your health insurer or health plan for such Medical Services. You understand and agree that any outstanding balance for Medical Services rendered by us that are not covered by your insurance will be charged to your credit card on file, and that our submission of a claim to your health insurer or health plan is not a waiver of our rights to seek payment from you.
YOU UNDERSTAND THAT YOU MAY BE CHARGED A FEE FOR MISSED APPOINTMENTS OR FOR APPOINTMENTS CANCELED WITH LESS THAN 48 HOURS’ NOTICE.
Consent to Treatment and HIPAA. By agreeing to these Medical Terms of Services, you consent to our provision of medical care to you and maintaining a medical record in an electronic format, subject to the regulations of HIPAA.
Behavioral and Mental Health Services. Our Medical Services include behavioral and mental health services. You agree to inform us if you have thoughts of self-harm or harming others, so that we can provide medical support (including, if necessary, behavioral and psychological questionnaires).
Consent to Electronic Communications. By utilizing the Medical Services, you consent to receiving certain electronic communications from us as further described in our Privacy Policy. Please read our Privacy Policy to learn more about our electronic communications practices. You agree that any notices, agreements, disclosures, or other communications that we send to you electronically will satisfy any legal communication requirements, including that those communications be in writing.
Limitation of Liability. TO THE FULLEST EXTENT PERMITTED BY LAW, IN NO EVENT WILL WE AND OUR AGENTS, AFFILIATES, PROVIDERS, EMPLOYEES, DIRECTORS, OR OFFICERS BE LIABLE TO YOU FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES (INCLUDING DAMAGES FOR LOSS OF PROFITS, GOODWILL, OR ANY OTHER INTANGIBLE LOSS) ARISING OUT OF OR RELATING TO YOUR ACCESS TO OR USE OF, OR YOUR INABILITY TO ACCESS OR USE, THESE MEDICAL SERVICE OR ANY MATERIALS OR CONTENT RELATED TO THE MEDICAL SERVICES, WHETHER BASED ON WARRANTY, CONTRACT, TORT (INCLUDING NEGLIGENCE), STATUTE, OR ANY OTHER LEGAL THEORY, AND WHETHER OR NOT ANY SPECIFIC ENTITY HAS BEEN INFORMED OF THE POSSIBILITY OF DAMAGE.
TO THE FULLEST EXTENT PERMITTED BY LAW, EXCEPT IN CASE OF NEGLIGENCE OR WILFILL MISCONDUCT, IN NO EVENT WILL WE AND OUR AGENTS, AFFILIATES, PROVIDERS, EMPLOYEES, DIRECTORS, OR OFFICER BE LIABLE FOR PERSONAL INJURY OF ANY SORT OR DEATH, RESULTING FORM ANYONE’S USE OR INABILITY TO ACCESS OR USE TE MEDICAL SERVICES.
Telehealth Services. The Medical Services offered by us include telehealth services. As part of those telehealth services, you consent to receive electronic communications from us relating to the provision of telehealth services. Those communications may include Protected Health Information as that term is defined under HIPAA. By utilizing our telehealth Medical Services, you understand that we will record, transcribe and process your personal and medical information. Additional information related to our telehealth Medical Services and consent to receive telehealth services are located here. Please review the Index Clinic Consent to Telehealth Services before using the Medical Services.
General Provisions. These Medical Terms of Service and any other agreements expressly incorporated by reference into these Medical Terms of Service, are the entire and exclusive understanding and agreement between you and us regarding your Medical Services. You may not assign or transfer these Medical Terms of Service or your rights under these Medical Terms of Service, in whole or in part, by operation of law or otherwise, without our prior written consent. We may assign these Medical Terms of Service and all rights granted under these Medical Terms of Service, at any time without notice or consent. The failure to require performance of any provision will not affect our right to require performance at any other time after that, nor will a waiver by us of any breach or default of these Medical Terms of Service, or any provision of these Medical Terms of Service, be a waiver of any subsequent breach or default or a waiver of the provision itself. Use of Section headers in these Medical Terms of Service is for convenience only and will not have any impact on the interpretation of any provision. Throughout these Medical Terms of Service the use of the word “including” means “including but not limited to.” If any part of these Medical Terms of Service is held to be invalid or unenforceable, then the unenforceable part will be given effect to the greatest extent possible, and the remaining parts will remain in full force and effect.
