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Katherine L. Boyd MD 28755 Schoenberg Rd Warren, MI 48088 5865737222 M:95, T:116:30, TH:81 F:91 The PatientProvider Partnership Agreement The health and wellness of our patients is a top concern of

How to fill out form patient-provider partnership agreement

Who needs the form patient-provider partnership agreement?

1. Patients who are seeking healthcare services and want to establish a partnership with their healthcare provider.
2. Healthcare providers who want to establish clear guidelines and expectations for their patients.

How to fill out the form patient-provider partnership agreement:

1. Begin by providing basic information about the patient, such as their name, contact information, and date of birth.
2. Include the healthcare provider's information, including their name, practice name, and contact details.
3. Specify the purpose of the agreement, which is to establish a partnership between the patient and the healthcare provider for the provision of healthcare services.
4. Clearly define the responsibilities and obligations of both parties. This may include the patient's commitment to providing accurate medical history and information, following the healthcare provider's advice, and attending appointments. The healthcare provider may outline their responsibilities such as ensuring quality care, explaining treatment plans, and respecting the patient's rights.
5. Indicate the goals and objectives of the partnership, such as promoting patient-centered care, improving communication, and fostering mutual trust and respect.
6. Include any specific terms and conditions that both parties should adhere to, such as confidentiality of medical records, payment arrangements, and dispute resolution procedures.
7. Incorporate any necessary legal language or clauses to protect both the patient and the healthcare provider's rights and obligations.
8. Sign and date the agreement. Ensure that both the patient and the healthcare provider sign the document to signify their understanding and acceptance of the terms stated in the partnership agreement.
9. Provide a copy of the signed agreement to both the patient and the healthcare provider for their records.
10. Regularly review and update the agreement as needed, to reflect any changes in the patient's medical condition or treatment plan, as well as any changes in the healthcare provider's practice policies.

It is essential for both patients and healthcare providers to consider filling out the form patient-provider partnership agreement as it establishes clear expectations, promotes effective communication, and ensures a collaborative approach to healthcare decision-making.

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