Patricia Nguyen · Jan 2024 - Dec 2026
Service Provider
Dr. James Mitchell
Family Medicine & Internal Medicine
info@mitchellfamilypractice.com
Client
Patricia Nguyen
patricia.nguyen@email.com
Dr. James Mitchell of Mitchell Family Practice agrees to provide ongoing chronic care management for Type 2 Diabetes Mellitus, including quarterly in-office consultations, laboratory monitoring, medication management, dietary and lifestyle counseling, and care plan coordination.
This agreement shall be effective from January 20, 2024 through December 31, 2026, and will be reviewed annually. Either party may terminate with 30 days written notice.
The Patient agrees to pay $200 per monthly care appointment. Quarterly lab panels are billed separately at $150 per panel. The annual wellness exam is included for Comprehensive Care Membership holders.
Missed appointments without 24-hour notice will incur a $75 cancellation fee. The Patient may cancel the ongoing care plan with 30 days written notice.
All patient medical records remain confidential and are governed by HIPAA regulations. Care plan goals and medications will be reviewed and adjusted at each quarterly visit.
Service Provider
Dr. James Mitchell
Signature
Client
Patricia Nguyen
Signature
Signed on January 18th, 2024