Specialist – Patient Provider AgreementPatient Provider Agreement • January 31st, 2022
We are partnering with your Primary Care Physician (PCP) who is your Patient Centered Medical Home. We are sharing their commitment to effectively and efficiently work together to manage your care. As your Specialist, we will be sharing information about your condition and provide recommendations, guidance and periodic follow-up.
Patient-Centered Medical HomePatient-Provider Agreement • September 25th, 2020
• Prepare for an office visit by telling us about ALL current medications you take, including over-the-counter, vitamins and herbals, and any refills you need
PATIENT-‐PROVIDER AGREEMENTPatient-Provider Agreement • November 10th, 2020
Welcome and thank you for choosing our practice. Our mission is to provide you with the highest quality patient-‐centered medical care in an environment that is nurturing, empowering, supportive and loving. We are committed to providing your child with the best medical care based on his/her health needs. Our hope is that we can form a partnership to keep your child as healthy as possible.
Patient-Provider AgreementPatient-Provider Agreement • September 20th, 2021
Establish a strong link with the patients that encourage open and honest discussions regarding your health and associated care plans
Patient-Provider AGREEMENTPatient-Provider Agreement • February 15th, 2017
Tell us about medications being taken, and ask for refills in a timely manner. Ask for your refills at the time of your office visit. Otherwise, give the office staff at least 24 hours notice to complete refills.
PCP Patient Provider Agreement Sacred Heart Medical Centre PC 9912 E Grand River Ave, Suite 1000 Brighton, MI 48116Patient Provider Agreement • February 14th, 2019
Thank you for partnering with our office and taking an active role in your health. In order to enhance our partnership it important we share some helpful practice information
Patient-Provider Agreement – Hepatitis CPatient-Provider Agreement • September 27th, 2019
treatment for Hepatitis C and that I may be required to submit to a drug screen at the discretion of my healthcare provider.
OB/GYN – Patient Provider AgreementPatient Provider Agreement • May 14th, 2020
We are partnering with your Primary Care Physician (PCP) who is your Patient Centered Medical Home. We are sharing their commitment to effectively and efficiently work together to manage your care. As your Specialist, we will be sharing information about your condition and provide recommendations, guidance and periodic follow-up.
Neurology – Patient Provider AgreementPatient Provider Agreement • May 14th, 2020
We are partnering with your Primary Care Physician (PCP) who is your Patient Centered Medical Home. We are sharing their commitment to effectively and efficiently work together to manage your care. As your Specialist, we will be sharing information about your condition and provide recommendations, guidance and periodic follow-up.
ContractPatient/Provider Agreement • August 20th, 2021
Good communication between patients and physicians is the key to better outcomes. My staff and I are committed to providing you the highest quality medical care. This can best be accomplished by a clear understanding about our responsibilities to you, and your rights and responsibilities as a patient in our practice.
Patient Provider Agreement on Opioid TherapyPatient Provider Agreement • June 20th, 2016
PURPOSE: The purpose of this agreement is to protect your access to controlled substances and to protect our ability to prescribe for you.
Office Policies and Patient-Provider AgreementPatient-Provider Agreement • July 27th, 2020
PCMH Patient-Provider AgreementPatient-Provider Agreement • May 16th, 2019
A Patient Centered Medical Home is a trusting partnership between a provider-lead healthcare team and an informed patient. It includes an agreement between the provider and the patient that acknowledges the role of each in the total healthcare program.
Specialist – Patient Provider Agreement Foot Healthcare Associates Livonia – Novi – SouthfieldPatient Provider Agreement • April 11th, 2017
We are partnering with your Primary Care Physician (PCP) who is your Patient Centered Medical Home. We are sharing their commitment to effectively and efficiently work together to manage your care. As your Specialist, we will be sharing information about your condition and provide recommendations, guidance and periodic follow-up.
Patient-Provider Agreement for Ongoing Use of Controlled MedicationPatient-Provider Agreement • August 27th, 2012
• If I must stop this medicine for any reason, I need to stop it slowly. Stopping it slowly will help me avoid feeling sick from withdrawal symptoms.
PATIENT-PROVIDER AGREEMENT AND INFORMED CONSENT ACUTE PAINPatient-Provider Agreement • October 26th, 2018
Financial AgreementPatient/Provider Agreement • January 4th, 2017
______ All patients 18 years and older will be required to give his/her social security number, unless payment in FULL with cash or credit is collected at the time of service (regardless of insurance coverage).
Patient Provider Agreement (PPA):Patient Provider Agreement • September 20th, 2018
The health and on-going care of our patients is a top priority of this office. Providing the best possible care to every patient is our primary goal. The only way we can meet this goal is if we, your care team and you, the patient, work together.
Patient-Provider AgreementPatient-Provider Agreement • October 7th, 2024
Establish a strong link with the patients that encourage open and honest discussions regarding your health and associated care plans
Office Policies and Patient-Provider AgreementPatient-Provider Agreement • July 20th, 2021
Patient Provider Agreement (PPA)Patient Provider Agreement • March 1st, 2017
The health and on-going care of our patients is a top priority of this office. Providing the best possible care to every patient is our primary goal. The only way we can meet this goal is if we, your care team and you, the patient, work together.
Office Policies and Patient-Provider AgreementPatient-Provider Agreement • November 2nd, 2024
PATIENT-PROVIDER AGREEMENT FOR DRIECT PRIMARY CARE SERVCIESPatient-Provider Agreement • April 8th, 2022 • Colorado
Telehealth NP, LLC representing various specialties through its Providers (i.e., pediatric, adult, family, geriatric, psychiatric or women’s health), delivers primary care within identified United States territories. In exchange for monthly membership fees, Telehealth NP, through its Providers, agrees to provide You (Patient) with the services described in this agreement on the terms and conditions contained therein.
Patient Provider AgreementPatient Provider Agreement • September 10th, 2021
NABER & GILL, M.D.s, P.C. MICHAEL J. NABER, M.D. MATTHEW A. GILL, M.D. JOSEPH M. BEALS, M.D.Patient-Provider Agreement • December 16th, 2020
● Establish a strong link with the patients that encourage open and honest discussions regarding your health and associated care plans
Specialist – Patient Provider Agreement Foot Healthcare AssociatesPatient Provider Agreement • May 12th, 2021
We are partnering with your Primary Care Physician (PCP) who is your Patient Centered Medical Home. We are sharing their commitment to effectively and efficiently work together to manage your care. As your Specialist, we will be sharing information about your condition and provide recommendations, guidance and periodic follow-up.
Patient-Provider Agreement – Hepatitis CPatient-Provider Agreement • June 8th, 2022
treatment for Hepatitis C and that I may be required to submit to a drug screen at the discretion of my healthcare provider.
ABC Allergy Clinic Patient – Provider AgreementPatient – Provider Agreement • April 18th, 2017
Our doctors, clinical team and staff will work with you to improve and maintain your health. Here is what you can expect from us, and what we ask from you in return.
ContractPatient / Provider Agreement • April 7th, 2011
ContractPatient / Provider Agreement • January 16th, 2021
Podiatry (Foot and Ankle) Patient-Provider AgreementPatient-Provider Agreement • May 22nd, 2019
ContractPatient-Provider Agreement • June 17th, 2019
THE PATIENT-PROVIDER AGREEMENTPatient-Provider Agreement • September 26th, 2017
The health and wellness of our patients is a top concern of this office. Providing the best possible care to every patient is our primary goal. The only way we can meet this goal is if I, your doctor, and you, my patient work together.
Patient-Provider AgreementPatient-Provider Agreement • March 2nd, 2021
Establish a strong link with the patients that encourage open and honest discussions regarding your health and associated care plans
