Requirements for a valid Sample Clauses

Requirements for a valid direct primary care agreement. a. In order to be a valid agreement, a direct primary care agreement must meet all of the following requirements: (1) Be in writing. (2) Be signed by the direct provider, or an agent of the direct provider, and the direct patient or the direct patient’s representative. (3) Describe the scope of the primary care health services covered by the direct primary care agreement. (4) State each of the direct provider’s locations where a direct patient may obtain primary care health services and specify any out-of-office primary care health services that are covered under the direct primary care agreement. (5) Specify the direct service charge and the frequency at which the direct service charge must be paid by the direct patient. A direct patient shall not be required to pay more than twelve months of a direct service charge in advance. (6) Specify any additional costs for primary care health services not covered by the direct service charge for which the direct patient will be responsible. (7) Specify the duration of the direct primary care agreement, whether renewal is automatic, and if required the procedure for renewal of the direct primary care agreement. (8) Specify the terms and conditions under which the direct primary care agreement may be terminated by the direct provider. A termination of the direct primary care agreement by the direct provider shall include a minimum of a thirty-calendar-day advance, written notice to the direct patient or to the direct patient’s representative. (9) Specify that the direct primary care agreement may be terminated at any time by the direct patient upon written notice to the direct provider. (10) State that if the direct primary care agreement is terminated by either the direct patient or the direct provider all of the following apply: (a) Within thirty calendar days of the date of the notice of termination from either party, the direct provider shall refund all unearned direct service charges to the direct patient. (b) Within thirty calendar days of the date of the notice of termination from either party, the direct patient shall pay all outstanding earned direct service charges to the direct provider. (11) Include a notice in bold, twelve-point font that states substantially as follows:
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