APPOINTMENTS:
972-548-7888

3701 Eldorado Parkway
McKinney, TX 75070
Office Hours || View Map


Printer Friendly
Forensic Services Agreement

This Forensic Services Agreement (the “Agreement”) must be signed by any patient or guardian of a patient (“you”) before you can become eligible to receive treatment or services from Pediatric Healthcare Associates.

Pediatric Healthcare Associates only provides in-office pediatric medical services to patients seeking treatment. Pediatric Healthcare Associates reserves the right, in Pediatric Healthcare Associates’ sole discretion, to decline to provide any services to client in any fashion or venue apart from a regularly scheduled in-office visit.

Pediatric Healthcare Associates does NOT provide forensic legal services to any parties, NOR does Pediatric Healthcare Associates desire to provide such services for clients, their families, or their adverse or potentially adverse parties.

Pediatric Healthcare Associates does NOT conduct forensic custody evaluations, social studies, or other forensic evaluations for patients for use in legal proceedings, whether in court or out of court.

Pediatric Healthcare Associates ONLY provides pediatric medical treatment to patients who seek to improve their health or to identify and treat medical issues. Pediatric Healthcare Associates will not, under any circumstances, begin providing treatment to your child and later assume an engagement for forensic services, whether intentionally or unintentionally.


Pediatric Healthcare Associates understands, however, that your life circumstances may change, and you may (or a court or another party involved in litigation with or against you may) compel or otherwise seek to have Pediatric Healthcare Associates personnel appear for a deposition, court testimony, or appear for some other legal proceeding. PEDIATRIC HEALTHCARE ASSOCIATES CANNOT CHARGE YOUR INSURANCE FOR THESE PURPOSES AND SERVICES.  Due to insurance reimbursement restrictions, to the extent you (or any other party involved in litigation with or against you) wish to secure Pediatric Healthcare Associates’ services for any reason (other than for an in-office visit for pediatric medical treatment), including services or appearances in anticipation of a lawsuit or after the commencement of a lawsuit or any and all matters compelled by lawful subpoena or court order pertaining to client matters (collectively referred to hereafter as “Forensic Services”), you must pay, in full and in advance for such requested services according to the terms of this Agreement. To the extent any such Forensic Services are reimbursed or covered by your insurance, it is your sole responsibility to file any required or necessary paperwork to recover any fees charged by Pediatric Healthcare Associates for Forensic Services.

Your Payment Obligation for Forensic Services
You agree to pay Pediatric Healthcare Associates $300 per hour for Forensic Services provided by registered nurses and staff members. You agree to pay Pediatric Healthcare Associates $400 per hour for Forensic Services provided by licensed physicians.

Pediatric Healthcare Associates will charge you as follows:
  • Pediatric Healthcare Associates requires payment for a minimum three-hour time commitment by Pediatric Healthcare Associates for any Forensic Services. You must pay Pediatric Healthcare Associates a minimum, non-refundable, threehour retainer ($900 or $1,200 as outlined above) prior to Pediatric Healthcare Associates’ preparation or travel for the provision of Forensic Services.
  • Pediatric Healthcare Associates will charge you in quarter-hour (15 minute) increments for Forensic Services.
  • Pediatric Healthcare Associates will charge you for any travel time and waiting time incurred by Pediatric Healthcare Associates in the course of provision of these Forensic Services, in addition to any time actually spent providing Forensic Services.
  • Pediatric Healthcare Associates will charge you the full costs associated with any travel for the provision of Forensic Services, in addition to fees for Pediatric Healthcare Associates’ time in the provision of Forensic Services (as outlined above). You will be responsible for paying 100% of all travel costs incurred by Pediatric Healthcare Associates.
Further, to the extent possible, you also agree to give the nurse, staff member, or licensed physician twenty-one (21) days’ advanced notice of your need for Forensic Services from Pediatric Healthcare Associates, another party’s or court’s need for Forensic Services from Pediatric Healthcare Associates, or any event requiring our attendance.

Client understands, agrees, and consents that Pediatric Healthcare Associates may disclose client’s confidential information or Protected Health Information (“PHI”) in the possession of Pediatric Healthcare Associates as reasonably necessary to comply with the requirements of any lawful subpoena or court order.

I agree to the foregoing terms of the Forensic Services Agreement as indicated by my signature below:

   
Date:
CalendarNow



3701 Eldorado Parkway, Suite A, McKinney, TX 75070 972-548-7888 www.phamckinney.com

Is Your Child Sick?TM

Browse over 100 articles to help you manage your child's symptoms.

Medical Library

PEDIATRIC HEALTHCARE ASSOCIATES, PA
Copyright © 2014 Pediatric Healthcare Associates PA. | All rights reserved. PHA Privacy Policy.
Copyright © 2019 Pediatric Healthcare Associates PA - McKinney, TX. All rights reserved.