New Patient Fee Sample Clauses

New Patient Fee. The Ministry shall pay the FHN $100 for each New Patient that is enrolled up to a maximum of 50 patients per fiscal year. For each such enrolment a shadow billing code, Q013, must be billed in order for payment to be made. In addition, a 10% premium shall be added to this payment for those New Patients between 65 and 74 years of age and a 20% premium shall be added for those patients 75 and over. Note: In order for this fee to be paid, the FHN Physician must, in addition to enrolling the patient, complete with the patient a “New Patient Declaration Form” as set out in Schedule 7 of this Appendix. The Patient Declaration form requires the FHN Physician to agree to provide ongoing Comprehensive Care to the enrolled patient. Please note that the Ministry will undertake periodic reviews of claims for new patients and may request access to the New Patient Declarations, or contact the Physician, or contact the patient to verify the accuracy of the claims.
Sample 1
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New Patient Fee. The Ministry shall pay the FHG Physician $100 for each New Patient that is registered up to a maximum of 50 patients per fiscal year. For each such enrolment a shadow billing code, Q013, must be billed in order for payment to be made. In addition, a 10% premium shall be added to this payment for those New Patients between 65 and 74 years of age and a 20% premium shall be added for those patients 75 and over. Note: In order to earn this fee the FHG physician must, in addition to formally enrolling the patient, co-sign with the patient a “New Patient Declaration form” as set out in Appendix G. This fee will become effective October 1st, 2003 The Patient Declaration form requires the FHG Physician to agree to provide ongoing Comprehensive Care to the registered patient. Please note that the Ministry will undertake periodic reviews of claims for new patients and may request access to the New Patient Declarations, or contact the Physician, or contact the patient to verify the accuracy of the claims. APPENDIX “G” NEW PATIENT DECLARATION FORM Date I, (Patient Name) declare that I currently do not have a family physician due to one or more of the following circumstances: (Please mark applicable box) 🞏 My family physician has moved to another community. 🞏 I have moved to another community. 🞏 My family physician is no longer available due to illness/death. 🞏 My family physician is no longer available due to change of practice type. 🞏 Up to now I have not had, or felt I needed, a family physician. Patient Signature Patient Health Number I, (Physician Name) declare that the above patient is not a patient of mine or to the best of my knowledge is not a patient of any of the other participating physicians in the Family Health Group of which I am affiliated. I agree to accept this patient into my practice and to provide ongoing health care to this patient from the date of the document forward. I will keep this documentation available on file in my primary office location and will provide copies of the same to the Ministry of Health and Long- Term Care as and when required for verification purposes.
Sample 1

Related to New Patient Fee

  • CONTINGENT FEE CONSULTANT warrants, by execution of this contract that no person or selling agency has been employed, or retained, to solicit or secure this contract upon an agreement or understanding, for a commission, percentage, brokerage, or contingent fee, excepting bona fide employees, or bona fide established commercial or selling agencies maintained by CONSULTANT for the purpose of securing business. For breach or violation of this warranty, LOCAL AGENCY has the right to annul this contract without liability; pay only for the value of the work actually performed, or in its discretion to deduct from the contract price or consideration, or otherwise recover the full amount of such commission, percentage, brokerage, or contingent fee.

  • Late Payment Fee If your account is subject to a Late Payment Fee, the fee will be charged to your account when you do not make the required minimum payment by or within the number of days of the statement Payment Due Date set forth on the Disclosure accompanying this Agreement.

  • Cleaning Fee Tenant hereby agrees to accept property in its present state of cleanliness. They agree to return the property in the same condition or pay a $200.00 minimum cleaning fee if the Landlord has to have the property professionally cleaned.

  • Management Fee For all services to be rendered, payments to be made and costs to be assumed by you as provided in sections 2, 3, and 4 hereof, the Trust on behalf of the Fund shall pay you in United States Dollars on the last day of each month the unpaid balance of a fee equal to the excess of (a) 1/12 of .55 of 1 percent of the average daily net assets as defined below of the Fund for such month; provided that, for any calendar month during which the average of such values exceeds $250,000,000 the fee payable for that month based on the portion of the average of such values in excess of $250,000,000 shall be 1/12 of .52 of 1 percent of such portion; provided that, for any calendar month during which the average of such values exceeds $1,000,000,000, the fee payable for that month based on the portion of the average of such values in excess of $1,000,000,000 shall be 1/12 of .50 of 1 percent of such portion; provided that, for any calendar month during which the average of such values exceeds $2,500,000,000, the fee payable for that month based on the portion of the average of such values in excess of $2,500,000,000 shall be 1/12 of .48 of 1 percent of such portion; provided that, for any calendar month during which the average of such values exceeds $5,000,000,000, the fee payable for that month based on the portion of the average of such values in excess of $5,000,000,000 shall be 1/12 of .45 of 1 percent of such portion; provided that, for any calendar month during which the average of such values exceeds $7,500,000,000, the fee payable for that month based on the portion of the average of such values in excess of $7,500,000,000 shall be 1/12 of .43 of 1 percent of such portion; provided that, for any calendar month during which the average of such values exceeds 10,000,000,000, the fee payable for that month based on the portion of the average of such values in excess of $10,000,000,000 shall be 1/12 of .41 of 1 percent of such portion; and provided that, for any calendar month during which the average of such values exceeds 12,500,000,000, the fee payable for that month based on the portion of the average of such values in excess of $12,500,000,000 shall be 1/12 of .40 of 1 percent of such portion; over (b) any compensation waived by you from time to time (as more fully described below). You shall be entitled to receive during any month such interim payments of your fee hereunder as you shall request, provided that no such payment shall exceed 75 percent of the amount of your fee then accrued on the books of the Fund and unpaid.

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