Medical Terms of Service
Effective Date: March 1, 2020
These Medical Terms of Service (“Medical Services Terms”) govern your use of the medical services, including Mobile Physician Office Services and Telehealth Services described in more detail in Section 10 and Section 11, respectively, below (“Medical Services”) provided by Modern Pediatrics professional corporations and our affiliated medical services providers (“Modern Pediatrics Professionals”, “we”, “us”, or “our”). Please read the Medical Services Terms carefully before using the Medical Services. By using the Medical Services, including the Telehealth Services, you agree to be bound by these Terms. If you are accepting these Medical Services Terms for another person (“Family Member”) as such Family Member’s guardian, conservator, or custodian, and as parent of a minor child Family Member, you agree to the terms, conditions, and notices contained or referenced herein on behalf of such Family Member.
Modern Pediatrics Professionals is affiliated with Modern Pediatrics, Inc. (“Modern Pediatrics”), where Modern Pediatrics provides management and administrative services to Modern Pediatrics Professionals. Modern Pediatrics also provides membership and other non-medical services to consumers, and the Membership Terms of Service govern your use of the services provided by Modern Pediatrics. Please read the Membership Terms of Service carefully before using Modern Pediatrics’ services.
Please refer to our Notice of HIPAA Privacy Practices to learn how Modern Pediatrics collects, uses, shares and protects your Protected Health Information (as defined under the Health Insurance Portability and Accountability Act of 1996 or "HIPAA").
Please do NOT use the Medical Services, including Mobile Physician Office Services and Telehealth Services, for emergency or urgent medical matters. For all urgent or emergency matters that you believe may immediately affect your health, you must immediately call 911 or go to the nearest emergency room or urgent care facility.
1. Updates to the Medical Services Terms
We may modify these Medical Services Terms from time to time. We will notify you of material changes by posting the amended terms on the Modern Pediatrics website and the Modern Pediatrics mobile application at least thirty (30) days before the effective date of the changes. If we have your email on file, we will also notify you of material changes to the Medical Services Terms by email at least thirty (30) days before the effective date of the changes. Please make sure we have your current email address so that you will receive notice of any material changes. If you do not agree with the proposed changes, you should discontinue your use of the Medical Services before the effective date of the change. If you continue using the Medical Services after the effective date, you will be bound by the updated Medical Services Terms.
2. Your Financial Responsibility; Assignment of Benefits
You agree to pay Modern Pediatrics Professionals all applicable charges at the prices then in effect for the Medical Services provided to you or another person on whose behalf you are accepting these Medical Services Terms and/or payment responsibility (such as your children or other family members) (“Covered Family Member”). You will be charged for the Medical Services, including complementary and alternative services provided to you or your Covered Family Member by a Modern Pediatrics Professionals healthcare service provider (each, a “Provider”). You authorize Modern Pediatrics Professionals to charge your chosen payment method (your "Payment Method") for the Medical Services provided to you or your Covered Family Member. If your Payment Method is invalid at the time payment is due, you agree to pay all amounts due upon demand. The third party services provider who manages your Payment Method may impose terms and conditions on you, which are independent of these Medical Services Terms, and you agree to comply with all of those terms. Modern Pediatrics Professionals may accumulate charges that you’ve incurred for the Medical Services and submit them as one or more aggregate charges during or at the end of each billing cycle. Modern Pediatrics Professionals reserves the right to correct any billing errors or mistakes even if payment has already been requested or received.
If you provide information about your health insurance or health plan, that will be deemed your authorization for us to submit claims for covered Medical Services to your health insurer or health plan. You hereby assign or otherwise authorize payment of medical benefits to us for the Medical Services provided to you or your Covered Family Member. You authorize the release of any medical or other information necessary to process any claims for the Medical Services provided. You further understand and accept your financial responsibility for any portion of the bill not covered by your health insurer or health plan. SUBMISSION OF CHARGES DOES NOT WAIVE OUR RIGHT TO SEEK PAYMENT DIRECTLY FROM YOU.
3. Appointments: Missed/Late Cancellation
You understand and agree that if you do not show for your appointment or you cancel your appointment with less than 24 hours’ notice, we may charge you a fee for a missed/late cancelled appointment.
4. Permission to Treat
You give permission to the Providers to medically care for you and your Covered Family Member. You may withdraw this consent at any time by no longer seeking Medical Services from Modern Pediatrics Professionals.
You understand and agree that as part of providing Medical Services to you, your Protected Health Information (as defined by HIPAA), including test results, may be released to an online personal health record and via communication with Modern Pediatrics Professionals’ healthcare team electronically (in accordance with our Notice of HIPAA Privacy Practices).
5. Service Termination
You may terminate your use of the Medical Services at any time by not using the Medical Services any more. We may terminate your use of the Medical Services at any time in our reasonable discretion, for causes including but not limited illegal conduct such as falsifying information to obtain controlled substances, abusive and threatening behavior, and continued refusal to pay for our services. We may terminate your use of the Medical Services by sending notice to you at the mail or email address you provided to us or by otherwise contacting you. If we terminate your use of the Medical Services, we will use reasonable effort to notify your insurer, if any.
6. Mental Health Services Disclaimer
Mental health services may involve discussing sensitive aspects of your life; you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, or helplessness. If at any point you experience significant increased distress or have thoughts of harming yourself or others, you agree to notify your mental health provider so that an appropriate level of support can be provided. Your mental health provider may utilize a set of psychological symptom questionnaires in order to assist with determining a diagnosis and track your progress in counseling, and may discuss the nature of these assessments and your results when applicable.
7. Consent to Electronic Communications
You agree that Modern Pediatrics Professionals may send the following to you by email or by posting them on our website and mobile application: legal disclosures; these Medical Services Terms, Notice of HIPAA Privacy Practices; future changes to any of the above; and other notices, policies, communications or disclosures and information related to the Medical Services. You agree that Modern Pediatrics Professionals may contact you via secure messaging, email, phone, text, or other online tools regarding the Medical Services. You consent to receive such communications electronically. You agree to update your contact information to ensure accuracy.
If you later decide that you do not want to receive certain future communications electronically, please send an email to email@example.com. You may also opt out of certain electronic communications through your account or by following the unsubscribe instructions in any communication you receive from Modern Pediatrics Professionals. Your withdrawal of consent will be effective within a reasonable time after we receive your withdrawal notice described above.
Modern Pediatrics Professionals will need to send you certain communications electronically regarding the Medical Services. You will not be able to opt out of those communications – e.g., communications regarding updates to these Medical Services Terms or information about billing. Your withdrawal of consent will not affect the legal validity or enforceability of the Medical Services Terms provided to and accepted by, you.
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, EXCEPT IN CASE OF NEGLIGENCE OR WILLFUL MISCONDUCT, WE AND OUR AFFILIATES, PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS WILL NOT BE RESPONSIBLE FOR ANY LOSS OR DAMAGE, INCLUDING PERSONAL INJURY OR DEATH, RESULTING FROM ANYONE'S USE OF OR INABILITY TO USE THE MEDICAL SERVICES.
The Medical Services are intended for use only within the United States and its territories. We make no representation that the Medical Services are appropriate, or are available for use outside the U.S. Those who choose to access and use our Medical Services from outside the U.S. do so on their own initiative, at their own risk, and are responsible for compliance with applicable laws.
9. Limitation of Liability
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, IN NO EVENT WILL WE AND OUR AFFILIATES, PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS BE LIABLE FOR ANY CONSEQUENTIAL, EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING WITHOUT LIMITATION THOSE RELATING TO LOST PROFITS OR THE COST OF SUBSTITUTE PRODUCTS OR SERVICES ARISING OUT OF OR IN CONNECTION WITH THE MEDICAL SERVICES OR FROM THE USE OF OR INABILITY TO USE THE MEDICAL SERVICES, WHETHER BASED ON CONTRACT, WARRANTY, PRODUCT LIABILITY, TORT OR OTHER LEGAL THEORY AND EVEN IF WE HAVE BEEN INFORMED OF THE POSSIBILITY OF SUCH DAMAGES. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SO THE ABOVE EXCLUSION MAY NOT APPLY TO YOU.
10. Mobile Physician Office Services
Modern Pediatrics Professionals provides non-emergent, mobile physician office services (“Mobile Physician Office Services”) at locations designated by its patients. Modern Pediatrics Professionals’ services include, general, primary-care services for pediatric patients, including vaccinations, wellness exams, annual physicals, etc., as well as short-notice, non-emergency, sick-care services for illnesses (such as colds, flu, stomach aches or ear infections) or minor injuries and mental health counseling services.
11. Telehealth Services and Permission
Modern Pediatrics Professionals may provide certain Telehealth (defined below) services to you ("Telehealth Services"). You consent to receive emails or other electronic communications from Modern Pediatrics Professionals pertaining to your care and your health, which may include Protected Health Information. You understand that virtual encounters via phone, email, video, or otherwise, could involve, and you hereby consent to the use of, automated tools for diagnosis, care, treatment or communication pertaining to healthcare matters. You also acknowledge that such virtual encounters may involve care by a variety of Providers, including Physicians, Registered Nurses, Nurse Practitioners, Physician Assistants, Nutritionists, Naturopathic Doctors, Therapists, and other support or medical personnel.
You give permission to Modern Pediatrics Professionals and the Telehealth Services Providers to record and process your personal details and medical data. You may withdraw these permissions at any time by no longer seeking Telehealth care from Modern Pediatrics Professionals.
"Telehealth" is the delivery of healthcare services using technology when the healthcare provider and patient are not in the same physical location, and/or the virtual delivery of healthcare services, including by a medical provider or via digital or automated tools, including without limitation tools for medical or health-related diagnosis and treatment. The Telehealth Services may be used for diagnosis, treatment, care, follow-up and/or patient education, and may include, without limitation, the following: electronic transmission of patient medical records, medical images, and/or other patient data or information; synchronous (i.e., "real time") and asynchronous (i.e., non-"real time") interactions via audio, video, text, and/or data or other electronic communications; automated, electronic or digital tools or services for diagnosis, care, treatment and/or communication pertaining to healthcare or medical matters; and output, transmission or exchange of data from medical devices, sound and video files. Further, you understand that it may be possible that your condition cannot be treated via the Telehealth Services, or that information transmitted through the Telehealth Services may not be sufficient or of too poor of image quality, or insufficient information or data to allow for appropriate medical decision making. Accordingly, you may be required to seek additional in-person medical care, alternative healthcare or emergency services. If your health or medical problem or condition persists after use of Telehealth Services, you will immediately contact your medical services provider and seek appropriate additional in-person medical care or emergency care, as appropriate.
12. General Provisions
These Medical Services Terms make up the entire agreement relating to your use of the Medical Services, and supersede all prior agreements relating to the subject matter hereof.
We may change, suspend, or discontinue any of the Medical Services at any time. We will try to give you prior notice of any material changes to the Medical Services. We will not be liable to you or to any third party for any modification, suspension or discontinuance of the Medical Services.
We may change, suspend, or discontinue any of our partnerships at any time. We will provide you with notices of such changes as applicable.
You may not transfer any of your rights or obligations under these Medical Services Terms to anyone else without our consent. Modern Pediatrics Professionals may assign our rights in connection with a merger, acquisition, or sale of assets, or by operation of law or otherwise.
Even after termination, these Medical Services Terms will remain in effect such that all terms that by their nature may survive termination will survive such termination.
If you have any questions about these Medical Services Terms, please contact firstname.lastname@example.org.