Common Contracts
1 similar Private Contract contracts
MEDICARE PRIVATE CONTRACTPrivate Contract • September 24th, 2018
This agreement is between [insert Dentists name] whose office is located at [insert clinic address], and Patient (indicated above) who is a Medicare beneficiary seeking services. The Patient has been informed that the Dentist has opted out of the Medicare Program under §1128, 1156 or 1892 of the Social Security Act effective [insert expected or known opt-out effective date] through [insert expected or known opt-out expiration date].
