Minor Patients. The adult accompanying a minor and the parents (or guardians) of the minor are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless services have been pre-authorized by the parents (or guardians) and payment has been made before or at the time of service in accordance with item number 3 above.
Appears in 5 contracts
Samples: Professional Service Agreement, Treatment and Financial Agreement, Professional Services Agreement
Minor Patients. The adult accompanying a minor and the parents (or guardians) of the minor are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless services charges have been pre-authorized to an approved credit plan, credit card, or payment by the parents (cash or guardians) and payment has been made before or check at the time of service in accordance with item number 3 abovehas been verified.
Appears in 1 contract
Samples: Financial Agreement
Minor Patients. The adult accompanying a minor and or the parents (or guardians) of the minor are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless services the minor has written permission for treatment and charges have been pre-authorized to an approved Visa/MasterCard/Discover Card or payment will be made by the parents (cash or guardians) and payment has been made before or check at the time of service in accordance with item number 3 aboveservice.
Appears in 1 contract
Samples: Financial Agreement
Minor Patients. The adult accompanying a minor and the parents (or guardians) of the minor are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless services have been pre-authorized by the parents (or guardians) and payment has been made before or at the time of service in accordance with item number 3 2 above.
Appears in 1 contract
Samples: hellobalanceconnection.com
Minor Patients. The adult accompanying a minor and the parents (or guardians) of the minor are responsible for full payment. For unaccompanied minors, non-emergency non-‐emergency treatment will be denied unless services have been pre-authorized pre-‐authorized by the parents (or guardians) and payment has been made before or at the time of service in accordance with item number 3 above.
Appears in 1 contract
Samples: Professional Service Agreement