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1. Parties: Identification of the healthcare provider and the patient (including full names, identification numbers, and contact details)
2. Background: Brief context explaining the purpose of the agreement for medical services payment
3. Definitions: Clear definitions of key terms used in the agreement
4. Payment Terms: Detailed explanation of fees, payment schedule, and accepted payment methods
5. Patient Responsibilities: Patient's obligations regarding timely payments, providing accurate information, and updating contact details
6. Healthcare Provider Obligations: Provider's commitments regarding service delivery and billing practices
7. Billing Procedures: Process for invoicing, statement generation, and payment processing
8. Default and Collections: Consequences of non-payment and collection procedures
9. Term and Termination: Duration of the agreement and conditions for termination
10. General Provisions: Standard legal clauses including governing law, amendments, and notices
11. Signatures: Execution section for both parties' signatures and dates
1. Medical Aid Claims: Include when patient has medical aid coverage - details process for medical aid claims and patient responsibilities
2. Payment Plan Terms: Include when offering installment payment options - specific terms for structured payment plans
3. Third-Party Payer Authorization: Include when payments will be made by a third party - authorization and responsibility details
4. Deposit Requirements: Include when upfront deposits are required - terms and conditions for deposits
5. International Patient Provisions: Include for non-South African residents - specific terms for international payments and jurisdiction
6. Digital Payment Terms: Include when offering electronic payment options - terms for digital payment methods
1. Schedule A: Fee Schedule: Detailed breakdown of standard fees for different services and procedures
2. Schedule B: Payment Plan Calculator: Table showing payment plan calculations and installment breakdowns
3. Schedule C: Accepted Payment Methods: List of all accepted payment methods and associated processing requirements
4. Appendix 1: Patient Information Form: Standard form for collecting patient details and payment preferences
5. Appendix 2: Direct Debit Authorization: Form for setting up automatic payment arrangements
6. Appendix 3: Medical Aid Information: Form for capturing medical aid details and claim procedures
Healthcare Provider
Patient
Medical Services
Payment Terms
Medical Aid Scheme
Medical Aid Benefits
Outstanding Balance
Due Date
Default
Payment Plan
Consultation
Treatment
Healthcare Facility
Invoice
Statement
Co-payment
Deposit
Emergency Care
Elective Procedure
Interest Rate
Late Payment Fee
Payment Method
Third-Party Payer
Authorized Representative
Consent
Personal Information
Practice
Professional Fees
Service Provider
Terms and Conditions
Working Day
Medical Practice
Collection Costs
Banking Details
Proof of Payment
Billing Procedures
Medical Aid Claims
Default and Collections
Confidentiality
Data Protection
Service Delivery
Patient Rights and Obligations
Healthcare Provider Rights and Obligations
Payment Methods
Interest and Late Fees
Dispute Resolution
Termination
Force Majeure
Indemnification
Assignment
Amendment
Notices
Governing Law
Severability
Entire Agreement
Third Party Rights
Consent and Authorization
Emergency Provisions
Record Keeping
Healthcare
Medical Services
Private Medical Practice
Hospital Services
Allied Health Services
Dental Services
Medical Insurance
Healthcare Administration
Financial Services
Finance
Administration
Legal
Compliance
Patient Services
Billing
Accounts Receivable
Practice Management
Front Office
Operations
Healthcare Practice Manager
Medical Practice Administrator
Financial Manager
Medical Billing Specialist
Healthcare Compliance Officer
Medical Secretary
Practice Owner
Healthcare Financial Controller
Patient Accounts Manager
Medical Practice Director
Healthcare Legal Advisor
Accounts Receivable Specialist
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