All fees as set out below shall apply to following Patient(s), who by submitting the form below agree to the terms and conditions of Middle River Healthcare Agreement.

• Family rate (2 adults and 2 children)
• Enrollment fee $99 per account*
• Re-enrollment fee (after one month paid of unpaid membership) $149 per account

This is an Agreement between Middle River Healthcare, LLC, (MRH), Jatu Karpeh, MSN, CRNP-BC (Master of Nursing Practice, Certified Registered Nurse-CRNP) in her capacity as owner of MRH, and you, (Patient) on this date.

Background

The CRNP, who specializes as a board-certified family nurse practitioner, delivers care on behalf MRH, at a designated office or at a private location of the patient. In exchange for certain fees paid by Patient, MRH, through its CRNP, agrees to provide Patient with the Services described in this Agreement on the terms and conditions set forth in this Agreement.

Definitions

• Patient. A patient is defined as those persons for whom the CRNP shall provide Services, and who are signatories to, or listed on the documents attached as Appendix 1, and incorporated by reference, to this agreement
• Services. As used in this Agreement, the term Services, shall mean a package of services or individual services both patient care and non-patient care, and certain
• amenities (collectively “Services”), which are offered by
• MRH and set forth in Appendix 1.
• Terms. This agreement shall commence on the date signed by the parties below and shall continue every month, automatically renewed each month.
• Fees. In exchange for the services described herein, Patient agrees to pay MRH, the amount as set forth in Appendix 1, attached. This fee is payable upon execution of this agreement and is in payment for the services provided to patient during the term of this Agreement. If this Agreement is cancelled by
• either party before the agreement termination date, then MRH shall refund
• the Patient’s pro- rated share of the original payment, remainingafter deducting individual charges for services rendered to patient up to cancellation.
• Non-Participation in Insurance. Patient acknowledges that he/she does not participate in any health insurance or HMO plans or Medicare or Federal Healthcare plans. Neither MRH nor CRNP shall make any representations whatsoever that any fees paid under this Agreement are 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. If the Patient is eligible for Medicare, or during the term of this Agreement becomes eligible for Medicare, then Patient is not eligible for MRH membership services. This agreement acknowledges your understanding that the CRNP does not provide membership services to patients participating in Medicare and Medicaid and will not seek reimbursement from Medicare, Medicaid, or any Federal Healthcare panels. Medicare, Medicaid, or any Federal Healthcare panels cannot be billed for any services performed for Patient by the CRNP. Patient agrees that he/she is not  participating in Medicare, Medicaid, or any Federal Healthcare panels and is solely responsible for any financial Fees for services received from MRH (Initials)
• Insurance or Other Medical Coverage. Patient acknowledges and understands that this Agreement is not a health insurance plan, and not a substitute for health insurance or other health plan coverage (such as membership in an HMO It will not cover hospital services, or any services not personally provided by MRH, or its Providers. Patient acknowledges that MRH has advised that patient obtain or keep in full force such health insurance policy(ies) or plans that will cover 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.
• Term; Termination. This Agreement will commence on the date first written above and will extend monthly thereafter. Notwithstanding the above, both Patient and MRH shall have the absolute and unconditional right to terminate the Agreement, without showing any cause for termination, upon giving 30 days prior written notice to the other party. Unless previously terminated as set forth above, at the expiration of the initial one-month term (and each succeeding monthly term), the Agreement will automatically renew for successive monthly terms upon the payment of the monthly fee each contract month.
• Communications. You acknowledge that communications with the Provider using e-mail, facsimile, video chat, instant messaging, and cell phone are not guaranteed to be secure or confidential methods of communications. As such, you expressly waive the provider’s obligation to guarantee confidentiality with respect to correspondence using such means of communication. You acknowledge that all such communications may become a part of your medical records. By providing Patient’s e-mail address on the attached Appendix 1, Patient authorizes the MRH, and its providers to communicate with Patient by e-mail regarding Patient’s “protected health information” (PHI) (as that term is defined in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and it’s implementing regulations).
• By inserting Patient’s e-mailaddress in Exhibit 1, Patient acknowledges that:
• (a) E-mail is not necessarily a secure medium for sending or receiving PHI and, there is always a possibility that a third party may gain access;
• (b) Although and the provider will make all reasonable efforts to keep e-mail communications confidential and secure, neither MRH, nor the provider can assure or guarantee the absolute confidentiality of e-mail communications;
• (c) Inthe discretion of the provider, e-mail communications may be made a part of Patient’s permanent medical record.
• (d) Patient understands and agrees that E-mail is not an appropriate means of communication regarding emergency or other time-sensitiveissues or for inquiries regarding sensitive information. In the event of an emergency, or a situation in which the member could reasonably expect to develop into an emergency, Member shall call 911 or the nearest Emergency Department, and follow the directions of emergency personnel. If Patient does not receive a response to an e-mail message within one business day (Monday through Friday), Patient agrees to use another means of communication to contact the provider. Neither MRH, nor the provider will be liable to Patient for any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to Patient as a result of technical failures, including, but not limited to, (i) technical failures attributable to any internet service
• provider, (ii) power outages, failure of any electronic messaging software, or failure toproperly address e-mail messages, (iii) failure of the Practice’s computers or computer network, or faulty telephone or cable data transmission, (iv) any interception of e-mail communications by a third party; or (v) your failure to comply with the guidelines regarding use of e-mail communications set forth in this paragraph.
• Change of Law. 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 forty-five days after of date of the effective date of change, then either party may immediately terminate the Agreement by written notice to the other party.
• Severability. If for any reason any provision of this Agreement shall be 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, and 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.

11. Reimbursement for services rendered. If this Agreement is held to be invalid forany reason, and if MRH therefore required to refund all or any portion of the monthly fees paid by Patient, Patient agrees to pay MRH an amount equal to the reasonable value of the services actually rendered to Patient during the period of time for which the refunded fees were paid.
12. Amendment. No amendment of this Agreement shall be binding on a party unlessit is made in writing and signed by all the parties. Notwithstanding the foregoing, the provider 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 are effective as of the date established by MRH, except that Patient shall initial any such change at MRH request. Moreover, if Applicable Law requires this Agreement to contain provisions that are not expressly set forth 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 set forth in this Agreement.

13. Assignment. This Agreement, and any rights Patient may have under it, maynot be assigned or transferred by Patient.
14. Relationship of Parties. Patient and the CRNP intend and agree that the CRNP,in performing their duties under this Agreement, is an independent contractor, as defined by the guidelines promulgated by the United States Internal Revenue Service and/or the United States Department of Labor, and the provider shall have exclusive control of her work and the manner in which it is performed.
15. Legal Significance. Patient acknowledges that this Agreement is a legal document and creates certain rights and responsibilities. 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 the Agreement.
16. Miscellaneous. This Agreement shall be construed without regard to anypresumptions or rules requiring construction against the party causing the instrument to be drafted. Captions in this Agreement are used for convenience only and shall not limit, broaden, or qualify the text.
17. Entire Agreement. This Agreement contains the entire agreement between theparties and supersedes all prior oral and written understandings and agreements regarding the subject matter of this Agreement.
18. Jurisdiction. This Agreement shall be governed and construed under the laws ofthe State of Maryland and All disputes arising out of this Agreement shall be settled in the court of proper venue and jurisdiction for MRH’s registered address in Essex, Maryland.
19. Service. All written notices are deemed served if sent to the mailing address of theparty written above or appearing in Exhibit A by first class U.S. mail. The parties have signed duplicate counterparts of this Agreement on the date first written above.