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Contract for administrative services provided to foreign patients in hospitals and medical institutions of Germany

between

Clinical Solutions GmbH
Innere Laufer Gasse 18, D-90403 Nürnberg

- henceforth referred to as "Clinical Solutions" -

and

Patient's first name
Patient's last name
Date of birth
Address
Diagnosis, planned course of treatment
Preliminary estimate of costs
EUR

- henceforth referred to as "Patient" -

The contract is made between the above named patient (or, in the event of the patient being under age, the above named guardian / guardians) and Clinical Solutions. Clinical Solutions shall provide administrative services to the patient during his / her out-patient or in-patient treatment at the clinics in Germany.

German clinics authorized Clinical Solutions to conduct administrative services for foreign patients in order to provide medical care services as well as to give timely and proper account of the costs of the treatment and their settlement.

The services provided by Clinical Solutions include:

- processing the information requests about treatment, examination and rehabilitation;

- drafting a preliminary cost estimate;

- ensuring a timely advance payment;

- controlling the costs arising during the treatment;

- if necessary, providing support to the patient at the clinic and translation into English;

- if necessary, help in obtaining visa for the patient and those accompanying him / her (providing the invitation to the Consular Department of the Embassy of Germany);

- if necessary, arranging an airport pick-up and transfer of the patient and those accompanying him / her to the clinic on the territory of Germany;

- if necessary, arranging the medical transportation for patients and those accompanying him / her on board of ambulance jets, accompanied by medical staff, or on board of charter VIP flights;

- drafting of the final invoice, including all bills for provided general hospital and other additional services;

- guarantee of the immediate transfer of the sum of overpayment back to the patient’s bank account, returning the unspent funds, if such are remaining, from the advance payment prepaid by the patient.

Clinical Solutions GmbH acts solely as a coordinator of administrative services between the clinic, involved physicians and the patient.

For the arrangement of all services Clinical Solutions charges a fee in the amount of 15% of the total cost of health care services of the clinic plus 19% VAT.

Additional services (e.g., pick-up at the airport, customer support and services of an interpreter in the clinic) may be provided by Clinical Solutions GmbH by agreement and are to be paid according to the provided price list.

All non-medical services on the German territory are subject to 19% VAT.

The amount of the advance payment corresponds to the amount of the provisional cost estimate prepared by Clinical Solutions.  The amount of the provisional cost estimate in the amount of EUR ___________________ covers the estimated cost of treatment at the clinic, payment to Clinical Solutions for its services, as well as transportation and accompanying interpreters’ services.

This amount shall be transferred in full and in advance to the bank account stated below. All costs associated with the transfer of payments are to be carried by the patient.

In the event of cancellation of planned outpatient examinations less than 3 days in advance, a penalty equal to 50% of their costs will be charged.

In the event of cancellation of planned outpatient examinations less than 1 day in advance, a penalty equal to 100% of their costs will be charged.

Trust account of Clinical Solutions GmbH:

Commerz Bank Nürnberg

Clinical Solutions GmbH

Konto Nr.: 01 922 622 00

BLZ: 760 800 40

IBAN: DE70 7608 0040 0192 2622 00

SWIFT/BIC: DRES DE FF 760

Clinical Solutions agrees to immediately report to the clinic about the receipt of the advance payment in the bank account of Clinical Solutions GmbH. Up until the preparation of the final consolidated bill, no later than six weeks after the date of discharge of the patient, the amount of advance payment shall remain in the bank account of Clinical Solutions GmbH upon the request of the clinic.

If during the treatment, the cost of treatment exceeds the amount of the advance payment as a result of complications or due to a need for additional medical services, Clinical Solutions shall require from the patient to make an appropriate additional payment.

Upon completion of treatment, Clinical Solutions shall draw up the combined final bill on behalf of the clinic. If the amount of the final bill exceeds the amount of the advance payment, the patient agrees to transfer the remaining amount to the above bank account. If the amount of the final bill is below the amount of advance payment, the patient is paid back the difference.

Clinical Solutions shall not be responsible for the quality of health services provided by the clinic, especially medical services rendered during medical examinations, treatment and hospital care.

Submitting a claim and demands toward Clinical Solutions to restitute damages as a result of unsatisfactory delivery of services by the clinic, conducted by doctors during examination and treatment, as well as during in-patient hospital care, is RULED OUT.

The patient agrees to submit legal claims of this kind exclusively to the clinic only directly.

Clinical Solutions, to the extent that is necessary and required, will recommend to the patient the appropriate parties (e.g. lawyers) who provide necessary for the legal claims services.

Clinical Solutions shall not be responsible for legal claims of restitution of damages that arise on behalf of the clinic to the patient, regardless of the legal grounds upon which they arise. If the clinic or its doctors turn directly to the patient for the implementation of legal claims for damages restitution as a result of a hospital stay or if such claims will be brought directly against Clinical Solutions, the patient agrees to release Clinical Solutions from the claims of the clinic and - in the event of judicial involvement - to advance the costs arising in connection with this claim.

The subject of the contract for providing the services is exhausted after clearing the final bill with the patient. This also terminates the period of the validity of the contract itself.

The right to terminate the contract without previous notice remains inviolable for both parties.

Changes and amendments shall only be legally effective if made in writing. Additional agreements are void if they are not made in writing.

This contract is subject to the legal jurisdiction of German law. German law of conflicts cannot be applied. All court proceedings are to be conducted in Nuremberg.

In the event of invalidity of individual provisions of this contract, all other provisions remain legally valid. In place of the invalid provision, the parties shall use a legally valid substitute regulation which comes closest to the adopted provision or the provision that would have been adopted if the parties knew about invalidity of the adopted provision. This rule shall also be applied to provisions that are not covered by the contract.

The right to cancel the contract in accordance with § 267 German Civil Code (BGB) is excluded.

Throughout the term of the validity of the contract, as well as after its expiry, the confidential data shall not be transmitted to third parties without a corresponding prior permission of the patient.

Employees and authorized representatives of the company Clinical Solutions GmbH agree not to violate the confidentiality and not to disclose the information to third parties during and after the cooperation with Clinical Solutions GmbH, Nuremberg.

With his signature the patient (in the event that the patient is under age - the patient’s guardian) confirms that he has familiarized himself with the provided price list and guarantees the payment of all final invoices from Clinical Solutions within two weeks after the receipt of the invoice.

If confirmed, the contract enters into force without the signature.

  

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