Direct Care Telehealth Patient Terms of Service
Dr. Nisha Jayani, MD, PMC
Last updated November 03, 2024
This is an agreement between Dr. Nisha Jayani, MD, PMC, and you, the undersigned (“Patient”).
1. Background. Dr. Jayani, a board-certified specialist in endocrinology, delivers care via telehealth. In exchange for certain fees paid by you as the Patient, Dr. Jayani agrees to provide the Patient with the Services described in this Agreement on the terms and conditions set forth herein.
2. Definitions
2.1. “Patient” means the person for whom Dr. Jayani shall provide Services and who is a signatory to, or listed on, the documents attached as Appendix 1, incorporated by reference into this Agreement.
2.2. “Services” refers to the services offered by Dr. Jayani and set forth in Appendix 1.
3. Term. This Agreement shall commence on the date signed by the parties below and shall continue for a period of one month, automatically renewing on a monthly basis.
4. Fees. In exchange for the services described herein, you agree to pay Dr. Jayani the amount set forth in Appendix 2. This fee is payable upon execution of this Agreement and covers services provided during the term of the Agreement.
5. Alternative Provider. If Dr. Nisha Jayani is unavailable to provide the Services described in this Agreement, including but not limited to telehealth consultations and other medical services, an alternative qualified healthcare provider may be designated to fulfill her obligations temporarily. Any alternative provider assigned to deliver Services under this Agreement will be a licensed NP, MD, or DO, ensuring continuity and quality of care. By entering into this Agreement, you consent to receive medical care from an alternative provider as outlined in this provision. You retain the right to decline care from the alternative provider and may request to reschedule your appointment when Dr. Jayani is available, subject to scheduling limitations. Any alternative provider will have access to your medical records as necessary to provide continuity of care. All patient information will be maintained in accordance with applicable privacy laws and the confidentiality terms outlined in this Agreement.
6. Non-participation in Insurance. You acknowledge that neither Dr. Jayani nor her practice participates in any health insurance or HMO plans, including Medicare, and does not submit claims for services rendered under this Agreement. You retain full responsibility for any determination regarding insurance or other third-party coverage. If eligible for Medicare or if you become eligible during the term of this Agreement, you will sign the agreement attached as Appendix 2, acknowledging Dr. Jayani’s opt-out status.
7. Insurance or Other Medical Coverage. You acknowledge and understand that this Agreement is not an insurance plan or a substitute for health insurance or other health plan coverage. It will not cover hospital services, or any services not personally provided by Dr. Jayani. You are advised to obtain or maintain a health insurance policy that covers general healthcare costs, as this Agreement is not intended to replace any existing or future health insurance coverage.
8. Termination. This Agreement will commence on the date first written in Appendix 1 and will extend monthly thereafter. Both you and Dr. Jayani have the right to terminate the Agreement, without cause, upon providing 30 days prior written notice. The agreement will be terminated immediately in the event (a) patient fails to make the monthly payment due, (b) Dr. Jayani determines Patient is not a good fit for the Services, or (c) Patient breaches any term of this agreement. Unless terminated, the Agreement will automatically renew for successive monthly terms upon payment of the monthly fee.
9. Communications. Patient acknowledges that communications with Dr. Jayani using email, telehealth platforms, video chat, and cell phone are not guaranteed to be secure or confidential methods of communication. As such, Patient expressly waives Dr. Jayani’s obligation to guarantee confidentiality with respect to correspondence using such means of communication. Patient acknowledges that all such communications may become a part of your medical records.
9.1. By providing Patient’s email address on the attached Appendix 1, Patient authorizes Dr. Jayani to communicate with Patient by email regarding Patient’s “protected health information” (PHI) (as that term is defined in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its implementing regulations). By inserting Patient’s email address in Appendix 1, Patient acknowledges that:
(A) Email is not a secure medium for sending or receiving PHI and there is always a possibility that a third party may gain access;
(B) Although Dr. Jayani will make all reasonable efforts to keep email communications confidential and secure, Dr. Jayani cannot ensure or guarantee the absolute confidentiality of email communications;
(C) Email communications may be made a part of Patient’s permanent medical record;
(D) Patient understands and agrees that email is not an appropriate means of communication regarding emergency or other time-sensitive issues or for inquiries regarding sensitive information. In the event of an emergency, or a situation that could reasonably be expected to develop into an Emergency, the Patient shall call 911 or the nearest Emergency room and follow the directions of the emergency personnel.
9.2. Neither Dr. Jayani nor her practice 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 technical failures attributable to any internet service provider, power outages, failures of any electronic message software, or failure to properly address email messages, failure of Dr. Jayani’s computers or computer network, or faulty telephone or cable data transmission, any interception of email communications by a third party, or Patient’s failure to comply with the guidelines regarding use of email communications set forth in this paragraph.
10. Research Eligibility. You acknowledge that as part of the services provided under this Agreement, PHI may be shared confidentially with clinical trial providers. This sharing is solely to determine your eligibility to participate in clinical trials for new therapies being tested. All shared PHI will be handled following applicable privacy laws, and only the minimum necessary information will be disclosed to ensure confidentiality and privacy. You retain the right to opt out of having your PHI shared for this purpose by notifying Dr. Jayani in writing.
11. Change of Law. If any law, regulation, or rule changes and substantially affects either party’s rights or obligations under this Agreement, either party may initiate renegotiation of the Agreement. If an agreement cannot be reached, either party may terminate the Agreement with written notice.
12. 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, that provision shall then be enforceable.
13. Reimbursement for Services Rendered. If this Agreement is held to be invalid for any reason, and if Dr. Jayani is therefore required to refund all or any portion of the monthly fees paid by Patient, Patient agrees to pay Dr. Jayani an amount equal to the reasonable value of Services actually rendered to Patient during the period of time for which the refunded fees were paid.
14. Amendment. No amendment of this Agreement shall be binding on a party unless it is made in writing and signed by both parties. Notwithstanding the foregoing, Dr. Jayani may unilaterally amend this Agreement to the extent required by federal, state, or local law or regulation (“Applicable Law”) by sending Patient 30 days written advance 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 Dr. Jayani, except that Patient shall initial any such change at Dr. Jayani’s 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.
15. Assignment. This Agreement, and any rights the Patient may have under it, may not be assigned or transferred by Patient.
16. Relationship of Parties. Patient and Dr. Jayani intend and agree that Dr. Jayani, in performing her 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 Dr. Jayani shall have exclusive control of her work and the manner in which it is performed.
17. 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.
18. Miscellaneous. This Agreement shall be construed without regard to any presumptions 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.
19. Entire Agreement. This Agreement contains the entire agreement between the parties and supersedes all prior oral and written understandings and agreements regarding the subject matter of this Agreement.
20. Jurisdiction. This Agreement shall be governed and construed under the laws of the state of California.
21. Dispute Resolution
21.1. In the event of any dispute, claim, or controversy arising out of or relating to this agreement, the parties agree to first attempt to resolve the matter through good faith negotiation. If the dispute cannot be resolved through negotiation within 30 days, the parties agree to submit the dispute to mediation before a mutually agreed-upon mediator in the state of California.
21.2. If the dispute is not resolved through mediation, it shall be finally resolved by binding arbitration conducted in accordance with the JAMS Comprehensive Arbitration Rules and Procedures. The arbitration will take place in the county where Dr. Jayani’s telehealth practice is located. The decision of the arbitrator shall be final and binding on the parties, and judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof.
21.3. Each party shall bear its own costs and expenses and an equal share of the mediator’s and arbitrator’s fees and administrative costs of arbitration. Notwithstanding the foregoing, either party may seek injunctive relief or other equitable remedies in a court of competent jurisdiction for any alleged breach of confidentiality or intellectual property rights.
22. Service. All written notices are deemed served if sent to the address of the party written in Appendix 1 by first-class U.S. mail.
Appendix 1: Telehealth Services
| Service Category | Included Services | Cost |
| Initial Consultation | ● 60-minute physician consultation including: o Comprehensive medical history review o Review of prior labs and imaging o Treatment plan development o Medication recommendations ● Unlimited email, phone, and text access for 30 days ● Communication to other physicians or insurance as necessary ● Discounted labs | $600 |
| Membership | ● 30-minute physician follow-up visits ● Unlimited email, phone, and text access ● Unlimited visits ● Communication to other physicians or insurance as necessary ● Discounted labs | $300 per month or $3300 annually |
| Non-Member Follow-up Visits | 30-minutes physician follow-up appointments ● Access via email, phone, and text ● Communication to other physicians or insurance as necessary ● Discounted labs | $400 per visit |
Excluded Services
● Emergency services
● Urgent care services