Terms and Conditions
Affordable Medical Clinics of Florida, LLC (AMC) Patient Care Agreement
Summary of AMC’s Practice. AMC provides medical care as set forth in this Agreement. AMC will not bill insurance. The services are intended to be affordable services billed directly to the patient after the services are rendered. The terms below provide more details regarding the services provided and the charges for those services. Please review the Agreement carefully, and let AMC know if you have any questions.
AMC’s Services. AMC will provide Basic Medical Care to patients. Basic Medical Care includes non-emergency, non-urgent medical care that is described below.
a. Terms of Services includes the following:
- Services provided include routine primary care/urgent care.
- Exceptions: no pelvic or breast examinations.
- Practice maintains the right to refuse service if the scope of the medical problem is felt to be outside of the level of expertise provided by the physician.
- Labs and diagnostics will not be performed on site and will be referred to outside facilities.
- A maximum of 2 medical issues or problems will be addressed per visit.
- Prescriptions and orders will be provided at the time of visit in paper format.
- Reprints of orders/prescriptions will not be provided without another visit.
- Refills of chronic medications will not be provided without another visit.
- Labs and diagnostics will not be ordered without prepayment from the patient for a second visit to review the results.
- It is the responsibility of the patient to make an appointment and review testing results with the physician.
- The practice will not call with results of any testing unless immediately life threatening results are identified. Nor will results be provided via telephone or other medium.
- Vaccinations will not be provided on site but recommended based on guidelines.
- Practice will request the patient to describe the medical problems that lead to the request for a visit before the visit with physician.
- Age appropriate health screening measures will be considered as a "problem" addressed during maintenance healthcare visits. Recommendations will be provided to the patient but follow through regarding these items (ie. colonoscopy, mammogram, psa etc) is the sole responsibility of the patient.
- The practice recommends that its patients have age appropriate health maintenance check ups. The patient may make an appointment for review of age appropriate health maintenance or request that it is included as a problem to be addressed during visits. Failure to address health maintenance will be the result of the patient declining the service and not the responsibility of the practice.
- No after hour or weekend service will be provided.
- Payment is due before the patient can be seen.
- All payments are non refundable.
- Requests for medical records - $1.00 a page for the first 25 pages and 25 cents a page after that.
Flat Fee: For $40.00 per visit (cash payment), $43.00 per visit (credit card payment). A maximum of 2 medical issues/problems will be addressed per visit.
AMC Does Not Bill Insurance: AMC is a private-pay practice and does not bill insurance. This is regardless of whether some of the services it provides are covered by insurance. AMC makes no representations or promises regarding whether their services are covered by insurance or reimbursable through a health care spending account or other health care product.
AMC Does Not Bill Medicare: Patient represents and warrants that Patient is not a Medicare beneficiary, and Patient agrees to neither submit a claim to Medicare for payment of the items or services provided by AMC under this Agreement, nor request that AMC submit such a claim.