英文医疗协议书.pdfVIP

MEDICAL SERVICES AGREEMENT THIS Medical Services Agreement is made this day of 2007, and made effective on the 1st day of , 2007 (Effective Date) by and between (Medical Services Entity), and Polk County Board of County Commissioners, a political subdivision of the State of Florida (County) (Medical Services Entity and County jointly the Parties). WITNESSETH: WHEREAS, the County has an indigent health care plan, hereinafter known as the Polk HealthCare Plan (Plan), and wishes to arrange for the provision of medical services to eligible county residents (Enrollees); WHEREAS, the Medical Services Entity is comprised of, or contracts with, one or more qualified physicians capable of meeting the credentialing criteria of the County; WHEREAS, the County desires to engage the Medical Services Entity to deliver, or arrange for the delivery of medical services to the Enrollees of its Plan; and WHEREAS, the Medical Services Entity is willing to deliver or arrange for the delivery of such services on the terms specified herein. NOW, THEREFORE, in consideration of the mutual promises set forth herein, and other good and valuable consideration, the parties hereby agree as follows: ARTICLE I DEFINITIONS 1.1 Claim. A statement of services submitted to the County by the Medical Services Entity following the provision of Covered Services to an Enrollee that shall include diagnosis or diagnoses date of service, CPT 4/HCPCS code and treating provider for services rendered to the Enrollee. 1.2 County. The designated division of the county