Hello! There are a few key terms I’d like you to understand before our consultation:

1. Parties: This Agreement is made between Dr. Rami MD Med Corp ("Physician" or "Practice"), a medical corporation, and the individual identified as the "Patient" below.

2. Services: The Physician agrees to provide the Patient with medical and non-medical services ("Services") within the Physician's scope of practice. The nature and extent of Services will be determined through consultation between the Physician and Patient.

3. Term and Renewal: This Agreement begins on the date signed by both parties and continues for one year. It automatically renews at the end of each year unless terminated by either party with 30 days written notice. Each consultation initiated by the Patient also renews this Agreement for the duration of that consultation.

4. Fees and Payment:

• The Patient agrees to pay the Practice's standard fees for Services. The current rate for our complete ENT specialist consultation is $400.00, but fees are subject to change.

• The Practice will provide the Patient with a complete fee schedule upon request.

• Payment is due in full upon receipt of a statement from the Practice.

5. Insurance:

• I spend my time with you, not billers, coders, and insurance companies.  I am happy to submit a claim on your behalf, and any payments received will be applied as credits to your account.  However, the consultation and/or service fee is due at the time of service.

• The Patient authorizes the Practice to bill their insurance carrier for Services, but the Patient remains ultimately responsible for all charges not covered by insurance.

• The Practice will credit your care fees with PPO coverage. I do not participate in any HMO plans.

• It is the Patient's responsibility to verify insurance coverage. I provide all records required for you to submit to your insurance for reimbursement. I do not submit appeals or respond to denials.

6. Dispute Resolution: Any disputes arising under this Agreement shall first be attempted to be resolved through good faith negotiation. If a resolution cannot be reached, the parties agree to submit the dispute to binding arbitration in accordance with the rules of the American Arbitration Association.  

7. Communications: All communication regarding the Patient's care should be directed to the Practice at the following:

Orella, Inc.
700 S Flower Street, Suite 1000
Los Angeles, CA 90017
Phone: (323) 655-6222
Fax: (323) 983-0888
Email: admin@orellahealth.com 

Details of the Agreement

 The Patient Agreement (the "Agreement") is effective upon the date signed on this agreement By and among Rami Abdou, MD ("Physician"), Dr. Rami MD Med Corp DBA Dr. Rami MD Med Corp ("Practice") , and the named patient "Patient."

In consideration of the mutual promises and undertakings set forth below, and for good and valuable consideration, the receipt and sufficiency of which are at this moment acknowledged, Practice, through its Physician, agrees to provide Patient with the Company Services described in the Agreement on the terms and conditions set forth below.

 The Patient represents and warrants that the information provided is accurate and complete and agrees to promptly notify the Practice of any changes.

Services

In consideration of the Consultation Fee, the Practice agrees to provide the Patient with the following service amenities (the "Program Services" ):

• Specialist Consultation and Examination – subject to availability in your area.

• Record of the case, including findings, assessment, and treatment recommendations.

• Prescriptions for any recommended/indicated studies, laboratory tests, medication, or consultations.

 The Patient explicitly acknowledges that the Physician will NOT provide (and the Company Services do NOT include) hospital, emergency, radiology, third-party, and laboratory services unless offered in a package and likely at an additional cost.

Charges

As outlined in the term above.

 The Patient authorizes the Practice and the Practice's designee to bill the total consultation cost to secure the booking. This is non-refundable unless canceled less than 24 hours before the appointment.

Non-Participation in Insurance Networks. 

The Patient acknowledges that the Practice is NOT IN NETWORK with health insurance plans. We may bill your insurance if you have out-of-network benefits and credit any payments received to your account. The Patient is responsible for determining eligibility and any uncovered costs. Fees paid under this Agreement are not covered by your health insurance or other third-party payment plans applicable to the Patient. The Patient shall retain full and complete responsibility for any such determination.

Insurance or Other Medical Coverage

Patient acknowledges and understands that this Agreement is not an insurance plan or substitute for health insurance or other health plan coverage (such as membership in a PPO). It will not provide or cover hospital services or any services not personally provided by Dr. Rami MD Med Corp or its Physician(s). The Patient acknowledges that Dr. Rami, MD Med Corp, has advised that the Patient obtain or keep such health insurance policies or plans in full force to cover the Patient for general healthcare costs. Patient acknowledges that this Agreement is not a contract that provides health insurance, and this Agreement is not intended to replace any existing or future health insurance or health plan coverage that Patient may carry. 

Designated Physician

Program Services will be personally provided by the Physician by the Agreement. The Patient understands and acknowledges that the Physician may not be available from time to time and may designate, temporarily, during her unavailability, an equally qualified covering physician or other licensed medical professional who will be allowed access to the Patient's medical history and course of care to attend to Patient's medical care needs. 

Additionally, the Patient acknowledges that the Practice will provide Program Services to patients and schedule appointments on a first-come, first-serve basis unless, in the Physician's sole discretion, a patient presents with a medical condition that dictates otherwise.

Term and Termination

The terms are practical for the duration of the consultation and for each additional paid consultation booked and paid for by the Patient. They will terminate once the case is closed and must be agreed to before any further services are provided.

Either Party may decline to renew the Agreement upon the written notification to the other Party at least 30 days before the expiration of the Initial Year or the Renewal Year as applicable. 

The Agreement may be terminated as follows:

• Patient may terminate this Agreement at any time following completion of a consultation.

• Patient may terminate this Agreement immediately if located in a locality outside the area of the Practice and Physician.

• The practice may terminate this Agreement at any time upon:

• The occurrence of the Patient's breach of the Agreement if such breach is not cured within ten days.

• Patient having an outstanding balance of $100 or greater on their Practice account if not paid within ten days after requested to do so or

• With 30 days prior written notice to the Patient, with or without cause, related to the patient-physician relationship or any other non-contract related issue, the Patient will be entitled to a refund of a prorated portion of the Membership Fee paid by the Patient for the year in which termination becomes effective.

This Agreement automatically terminates upon the death or dissolution of the other Party.

Communications

You acknowledge that electronic communications with the Physician are not secure or confidential methods of communication. As such, you expressly waive the Physician's obligation to guarantee confidentiality concerning correspondence using such means of communication. You acknowledge that all such communications may become a part of your medical records. By providing the Patient's email address, the Patient authorizes Dr. Rami MD Med Corp and its Physician to communicate with the Patient by email regarding the Patient's "protected health information" (PHI) (as that term is defined in the Health Insurance Portability and Accountability Act (HIPAA) of 1996. It's implementing regulations) Patient acknowledges that: 

• Email is not a secure medium for sending or receiving PHI, and a third party will have access; 

• Although the Physician will make all reasonable efforts to keep email communications confidential and secure, neither Dr. Rami MD Med Corp nor the Physician can assure or guarantee the confidentiality of email communications:

• At the discretion of the Physician, email communications may be made a part of the Patient's permanent medical record, and, 

• The Patient understands and agrees that email is not an appropriate means of communication regarding emergencies, other time-sensitive issues, or inquiries regarding sensitive information. In the event of an emergency or a situation in which the Patient could reasonably expect to develop into an emergency, the Patient shall call 911 or the nearest Emergency room and follow the directions of emergency personnel. Suppose the Patient does not receive a response to an email message. In that case, the Patient agrees to use another means of communication to contact the Physician. Neither Dr. Rami MD Med Corp nor the Physician will be liable to the Patient for any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to the Patient. 

• If there is a change of any law, regulation, or rule, federal, state, or local, which affects the Agreement, including these Terms & Conditions, which are incorporated by reference in the Agreement, or the activities of either Party under the Agreement, or any change in the judicial or administrative interpretation of any such law, regulation or rule, and either Party reasonably believes in good faith that the change will have a substantial adverse effect on that Party's rights, obligations or operations associated with the Agreement, then that Party may, upon written notice, require the other Party to enter into good faith negotiations to renegotiate the terms of the Agreement including these Terms & Conditions. If the parties are unable to reach an agreement concerning the modification of the Agreement within thirty days after of date of the effective date of the change, then either Party may immediately terminate the Agreement by written notice to the other Party 

Independent Medical Judgment

Notwithstanding anything to the contrary in this Agreement, the Physician retains complete and free discretion. The Physician shall exercise her best professional medical judgment on behalf of the Patient concerning medical services rendered to the Patient. Nothing in this Agreement shall be deemed or construed to influence, limit, or affect a physician's independent medical judgment concerning the provision of medical services to the Patient by Physician or Practice.

Terms of Usage

The Practice may designate specific Terms of Usage for Patients as a supplement to this Agreement by providing written notice to patients. If the Practice assigns any Terms of Usage, such terms shall control over conflicting terms in this Agreement.

Change of Law

If there is a change in any state or federal law, regulation, rule, or interpretation thereof that affects this Agreement or the activities of either Party under this Agreement, and either Party reasonably believes in good faith that the change will have a substantial adverse effect on that Party's rights or obligations under this Agreement, then that Party may, upon written notice, require the other Party to enter into good faith negotiations to renegotiate the terms of this Agreement. If the parties are unable to reach an agreement concerning the modification of this Agreement within thirty (30) days after the date of the notice seeking renegotiation, then either Party may terminate this Agreement by written notice to the other Party; in such case, Patient will be entitled to a refund of prorated portion of the Membership Fee paid by the Patient for the year in which termination becomes effective.

Severability  

If, for any reason, any provision of this Agreement is deemed by a court of competent jurisdiction to be legally invalid or unenforceable in any jurisdiction to which it applies, the validity of the remainder of the Agreement shall not be affected. That provision shall be deemed modified to the minimum extent necessary to make that provision consistent with applicable law and in its modified form, and that provision shall then be enforceable. 

Notice

Any communication required or permitted to be sent under this Agreement (other than communications referenced in Section 8 relating to the Patient's PHI) will be in writing and sent via facsimile, recognized overnight courier, or certified mail, return receipt requested, to the addresses indicated on this document. Any address change will be communicated to the Parties by the provisions of this Section 13.

Amendment 

No amendment of this Agreement shall be binding on a party unless it is made in writing and signed by all the parties. Notwithstanding the preceding, the Physician may unilaterally amend this Agreement to the extent required by federal, state, or local law or regulation ("Applicable Law") by sending You 30 days advance written notice of any such change. 

Any such changes are incorporated by reference into this Agreement without the need for signature by the parties and Dr. Rami MD Med Corp effective as of the date established by Dr. Rami MD Med Corp, except that Patient shall initial any such change at Dr. Rami MD Med Corp request. Moreover, if Applicable Law requires this Agreement to contain provisions that are not expressly outlined in this Agreement, then, to the extent necessary, such provisions shall be incorporated by reference into this Agreement and shall be deemed a part of this Agreement as though they had been expressly outlined in this Agreement. 

Assignment

The Patient may not assign the Agreement to another individual.

Legal Significance

The Patient acknowledges that this Agreement is a legal document that creates certain rights and responsibilities. The Patient also acknowledges having had a reasonable time to seek legal advice regarding the Agreement and has either chosen not to do so or has done so and is satisfied with the terms and conditions of this Agreement.

Governing Law/Arbitration

This Agreement shall be governed and interpreted by, and the parties' rights shall be determined by, the laws of the State of California, without regard to conflicts of laws principles. The parties intentionally and voluntarily waive any right to a trial by jury in any matter arising out of this Agreement. Any dispute between Patient and Physician and or Practice or their respective affiliates and agents arising under or relating to this Agreement shall be resolved exclusively by binding arbitration in Los Angeles County, California, before a neutral arbitrator, under the auspices of the American Arbitration Association, by the Expedited Rules and Procedures for Commercial Arbitration in effect at the time of arbitration. Any award rendered under such arbitration shall be final and binding upon the parties, and judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction over the parties. Each Party shall bear its costs and attorneys' fees for any such arbitration.

Waiver

The failure of a party to insist upon strict adherence to or performance of any term of the Agreement on any occasion will not be considered a waiver of the right to require adherence on any other occasion or regarding any other matter.

Service

All written notices are deemed served if they are sent by first-class U.S. mail to the address of the Party as entered in the Practice Electronic Health Record. 

Entire Agreement

This Agreement contains the entire Agreement between the parties. It supersedes all prior oral and/or written understandings and agreements regarding the subject matter of this Agreement subject to any Terms of Usage designated by Practice as set forth above.