AllTrans Medical, L.L.C.
The following terms and conditions of rental/purchase shall apply to all patients/recipients (hereinafter “Recipient) using equipment (hereinafter “Equipment”) furnished by AllTrans Medical L.L.C. (hereinafter “AllTrans”)
RESPONSIBILITY FOR PAYMENT: the Recipient agrees to accept full responsibility for payment of all monies due AllTrans for rental, purchase and supplies associated with the use of the Equipment.
INSURANCE: AllTrans (or its authorized agents) may, at its option, invoice the Recipients primary insurance carrier for rental and/or purchase of the Equipment. The Recipient agrees to forward in full to AllTrans any insurance payment made to the Recipient for the Equipment, services and supplies provided to the patient by AllTrans for which AllTrans has billed the Recipients insurance provider.
OWNERSHIP: The testing equipment shall remain the sole and exclusive property of AllTrans.
USE: Recipient agrees that the Equipment shall be used solely by Recipient and solely for the purpose for which the Equipment is intended. Patients with inconclusive home sleep test results may need a lab based study. Recipient agrees to use the Equipment in compliance with all applicable statutes, ordinances, rules and regulations of any federal, state or local authority.
HOLD HARMLESS: Recipient agrees to save, hold harmless and indemnify AllTrans against any and all liability or loss whatsoever resulting from the Recipients use of the Equipment.
LIMITATION OF REMEDIES: In no case shall AllTrans be liable under any legal or equitable theory for any special, incidental or consequential damages, including, but not limited to, damages for personal injury, injury to other property or for loss of income.
DISCLAIMER OF WARRANTIES: Recipient acknowledges that AllTrans makes no claim, warranties or representations regarding the suitability of the Equipment for testing. Recipient further acknowledges that AllTrans assumes no responsibility for the success or failure or any treatment administered through the use of the Equipment. Recipient agrees that no employees or agents of AllTrans or any other party are authorized to make any representations or warranties regarding the Equipment.
DEFAULT: The Recipient agrees to make all payment as required herein in the time and manner prescribed. In the event that Recipient fails to perform any or all the terms and conditions of this agreement, Recipient agrees that AllTrans may take any action under any legal or equitable theory, including but not limited to the following:
- Assess a late charge at the rate of 1.5% per month on any past due amounts;
- Request that the Equipment be immediately returned to AllTrans as provided above;
- Exercise any other right or remedy granted AllTrans pursuant to the terms of this agreement or pursuant to any laws of the state of Texas.
- Balance bill against credit card and / or check provided at contract inception.
ASSIGNMENT: Recipient hereby request that the payment of any insurance proceeds from any medical insurance program covering patient be made directly to AllTrans for any Equipment rented and / or purchased hereunder.
JURISDICTION & VENUE: This agreement shall be construed and enforced in accordance with the laws of the state of Texas. The venue for any suit or action to enforce any term or obligation of this agreement, specifically including any payment obligation, shall be, at the sole and exclusive option of AllTrans in Harris County, Texas.
ATTORNEYS FEES AND COSTS: If this agreement is referred to any attorney or collection agency for collection, or if a suit or action is instituted by an attorney for AllTrans to enforce any term of this agreement, Recipient shall pay all costs and attorney fees incurred by AllTrans in pursuing such suit or action.
CHANGE OF STATUS: I will not release equipment to any other person or corporation, or transfer equipment or supplies to another location.
AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION: This authorization is valid until the 180th day after the date it is signed unless it provides otherwise, not to exceed 24 months, or unless it is revoked and covers only treatment(s) for the dates covering testing and treatment. I, the undersigned, have read and authorize the staff of Alltrans Medical Solutions, LLC to obtain or disclose such information as herein contained. I have the right to revoke this authorization in writing at any time except to the extent that action has been taken in reliance upon it. I understand that when this information is used or disclosed pursuant to this authorization, it may be subject to re-disclosure by the recipient and may no longer be protected. I hereby release and hold harmless Alltrans Medical Solutions, LLC , its affiiliates, and designees from all liability and damages resulting from the lawful release of my Protected Health Information. Fees/charges will comply with all laws and regulations applicable to release of Protected Health Information.
ENTIRE AGREEMENT: This agreement sets forth the entire understanding between Recipient and AllTrans Medical Solutions.