Program Practice
Bundle

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Buy together and save! The quick-start set of the most essential documents needed for a package-or program-based practice:

• Patient Program Agreement (Three Months/Six Months);
• Informed Consent;
• Notice of Privacy Practices;
• Medicare Opt-out Affidavit & Instructions; and
• Private Contract.

Fee-For-Service Practice Bundle

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Buy together and save! The quick-start set of the most essential documents needed for a fee for service-based practice:

• Fee For Service Agreement;
• Informed Consent;
• Notice of Privacy Practices;
• Medicare Opt-out Affidavit & Instructions; and
• Private Contract.

Membership Practice
Bundle

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Buy together and save! Includes the most essential documents needed to start your cash-based functional medicine membership practice:

• Patient Membership
• Agreement;
• Informed Consent;
• Notice of Privacy Practices;
• Medicare Opt-out Affidavit & Instructions; and
• Private Contract.

Discontinuation
of Care Letter

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A document ensuring you meet your legal and ethical obligations to your patients, terminating your physician-patient relationship and ensuring the patient knows how to seek continued care elsewhere.

Patient Authorization and Consent for Release of Testimonial

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A written record of a patient giving your office permission to use their words (and sometimes recordings, image, likeness, name, age) in a variety of settings.

Medicare Opt-Out Affidavit and Instructions

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A sworn statement signed by a provider applying to opt-out of Medicare. It has technical requirements and must be submitted with a request to opt-out.

Private Medicare
Contract

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A patient contract between Medicare beneficiaries and providers who opt out of Medicare, explaining the nature of the opt-out status and the rights of the patient.

Notice of Privacy Practices Bundle

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Under HIPAA, covered entities are required to provide patients with a copy of the Notice of Privacy Practices, and the Acknowledgement provides the written proof of compliance with HIPAA.

Informed Consent

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A written record of a conversation between a provider and patient that includes a discussion of the risks, benefits, and alternatives of the care provided by the provider or their practice.

Program/Package Agreement (3 months, 6 months)

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An essential contract for your program/package patients which sets forth the division of liability by clearly outlining the rights and obligations of both the patient and practice.

Fee-for-Service
Agreement

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An essential contract for fee-for-service practices that sets forth the agreement between the practice and the patient; sets forth the division of liability; and sets forth how and when payment is to be made.

Patient Membership Agreement

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A patient agreement for membership practices. It describes the scope of your services and sets out what is and what is not included in the membership (which you can customize for your needs).

Office Policies and
Procedures

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What is it? A document outlining the policies and procedures of the office surrounding an initial consultation, including: Initial Consult Time limitations, Appointment Cancellation Policy, Refund Policy, and more.

Letter to Insurance
Carrier

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Use this letter as a template for you to notify any insurance carriers that you intend to work out-of-network in your functional medicine or other cash-based practice.

Website Essentials Bundle

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Buy together and save! This bundle includes the most essential documents you need for your website:

• Terms and Conditions;
• Privacy Policy; and
• Disclaimer
  
  
  

Website Terms & Conditions

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An agreement between you and your website visitors.It sets forth the division of liability by setting out the scope of what the website is and is not. It also sets the rules for their use of the site, tells them that the website is yours, and tells them what they can expect as a visitor. 

Website Privacy Policy

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A published policy that sets forth how your website treats and protects visitors’ personal information and contact information.

Website Disclaimer

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A statement explaining what your website is, what it is not, and how people should expect to interact with your website; which clearly sets forth the limitations of the information on your website and how the information can be used or interpreted.

Telemedicine Consent

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Legally required by a majority of states: A patient’s written consent for the use of telemedicine visits, including acknowledging the risks, benefits, and alternatives of the remote care provided by the provider or their practice.

Employment Contract Agreement- MD/DO

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An employment contract between your practice and an MD/DO for when you are ready to hire and expand your practice.

Employee Contract –
Office Staff

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An employee contract between your office and a staff member.

Employment Contract – Health Coach/Nutritionist

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An employment contract between your office and a health coach-level or nutritionist-level provider.

Independent Contractor Agreement – Health Coach/Nutritionist

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An independent contractor agreement between your practice and a health coach, nutritionist, dietician, or other complementary providers.

Independent Contractor Agreement – MD/DO/ND/DC/NP/PA

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An independent contractor agreement between your practice and an MD, DO, DC, ND, NP, PA, and other similarly situated providers.