DIRECT PRIMARY CARE MEMBERSHIP CONTRACT
Agreement
This Agreement is entered into on ________, 20, between: Coast and Aloe Medicine and Aesthetics
(Practice, Us, or We) and (Patient or You)
Clinical Independence Protection
Patient acknowledges that medical care involves professional clinical judgment. The Physician retains full authority to determine:
- Diagnosis
- Treatment selection
- Medication prescribing
- Procedure performance
- Referral necessity
- Medical risk evaluation
The Practice is not obligated to provide any requested treatment that the Physician determines to be medically inappropriate or unsafe. Medical outcomes cannot be guaranteed.
No Guarantee of Medical Result
Patient understands and agrees:
- Medicine is not an exact science.
- Disease progression may occur despite treatment.
- Individual response to therapy varies.
The Practice and Physician are not liable for natural disease course.
Scope of Membership Services Limitation
Membership provides access to primary care medical services when clinically appropriate.
Services are limited to:
- Office-based primary care medicine
- Preventive medicine
- Chronic disease management
- Selected minor procedures within physician competence
Membership does not guarantee availability of all medical services.
Emergency Care Disclaimer
Patient agrees:
- Practice services are not emergency medical services.
Medical emergencies must be directed to:
- 911 emergency services
- Emergency department evaluation
Failure to seek emergency care when medically indicated is patient responsibility.
Communication Risk Protection
Patient acknowledges:
- Email, text messaging, and electronic communication are not completely secure.
The Physician is not liable for:
- Delayed message response
- Technical system failure
- Communication interception
- Network outage
Nonurgent communication response is not guaranteed within a specific time frame.
Physician Clinical Judgment Authority
The Physician may:
- Refuse requested treatment when medically inappropriate
- Require physical examination prior to treatment decisions
- Modify treatment plans based on medical evaluation
- Restrict medication prescribing for safety reasons
Controlled substance prescribing is strictly governed by medical safety judgment.
Medication Prescribing Protection
The Practice may restrict prescribing of:
- High-risk controlled substances
- Habit-forming medications
- Medications considered medically unsafe for outpatient management
Patient must follow safe prescribing guidelines.
Liability Limitation Clause
To the maximum extent permitted under California law:
The Practice and Physician are not liable for:
- Indirect damages
- Consequential damages
- Emotional distress claims related to medical treatment
- Outcome dissatisfaction where medical care was appropriately rendered
Technical Failure Protection
The Practice is not responsible for delays caused by:
- Internet service interruption
- Telephone system failure
- Power outage
- Electronic medical record malfunction
- Third-party data access
Physician Absence Coverage
Temporary physician absence may occur.
Reasonable effort will be made to provide continuity of care.
Substitute clinical provider coverage may be arranged when appropriate.
Enrollment Protection
The Practice reserves the right to:
- Decline membership enrollment
- Terminate membership for clinical, safety, or operational reasons
- Modify service availability based on medical judgment
Age Restriction
Membership services are provided to patients 15 years of age and older.
Insurance Independence Statement
Patient acknowledges:
- Membership is not health insurance.
- Hospital services are not included.
- Catastrophic medical coverage is strongly recommended.
Legal Acknowledgment
Patient confirms:
- This Agreement is a legally binding medical service contract.
- Patient had opportunity to review terms.
- Patient may seek independent legal counsel.
California Jurisdiction
This Agreement is governed by the laws of the State of California.
Legal disputes shall be resolved in the appropriate court jurisdiction for the Practice location.
Signature Section
Patient Name (Printed): __________________________
Patient Signature: __________________________
Date: __________________________
Physician Representative:
Adrienne Burrows
Signature: __________________________
Date: __________________________