Mutual Agreements, Consents and Resolution of Concerns
1. Privacy and Ratings
Millennium Medical Management agrees not to provide medical information for the purpose of marketing directly to Patient. Regardless of legal
privacy loopholes, Millennium Medical Management will never attempt to leverage its relationship with Patient by seeking Pati ent’s consent for
marketing products for others.
We want your feedback. If our office gets it right, tell us. If we could do something better, tell us. We take quality improvement seriously. While
there are scores of “rating sites” in cyberspace, many fail to provide useful information. Let’s get it done right. We can make recommendations as
to which sites follow minimum standards for fairness and balance. Just ask us.
Millennium Medical Management has invested significant financial and marketing resources in developing the practice. Nothing in this Agreement
prevents a patient from posting commentary about Millennium Medical Management - our practice, expertise, and/or treatment - on web pages,
blogs, and/or mass correspondence. In consideration for treatment and the above noted patient protection, if Patient prepares such commentary
for publication on web pages, blogs, and/or mass correspondence about Millennium Medical Management, the Patient exclusively assigns all
Intellectual Property rights, including copyrights, to Millennium Medical Management for any written, pictorial, and/or electronic commentary.
This assignment shall be effective at the time of creation (prior to publication) of the commentary.
This Agreement shall be for a period of five years from Millennium Medical Management’s last date of service to Patient.
Millennium Medical
Management requires all patients in its practice to sign the Mutual Agreement to establish that any anonymous publishing or a iring of commentary
will be covered by this agreement. Further, this Agreement will survive for a minimum of three years beyond any termination of the Millennium
Medical Management - Patient relationship.
Patient and Millennium Medical Management acknowledge that breach of this Agreement may result in serious, irreparable harm. Patient and
Millennium Medical Management agree to the right of equitable relief (including but not limited to injunctive relief). Should a breach of this
provision result in litigation, the prevailing party in the litigation shall be entitled to reasonable costs, expenses, and attorney fees associated with
the litigation.
2. Surgical Consent Modification
We recognize that you have a choice in receiving care. We take great pride in our reputation for providing the highest levels of quality medical care
to our patients. However, we realize there are times when some patients might not be satisfied with the outcomes of their treatments.
Every patient has a right to file a complaint with the Division of Medical Quality Assurance, Board of Medicine. But, that right is not unlimited. For
example, those who file complaints in bad faith can be subject to civil liability (Florida Statutes§ 456.073 (11)). In the context of balancing your
rights with those of the physician, I, the patient, agree to the following:
1. If a complaint related to my care is ever filed (by my agent or me) with the Division of Medical Quality Assurance, I will only do so in
good faith, addressing matters only related to my health and welfare.
2. In particular, I understand that there are risks inherent to any surgical procedure and these risks have been explained to me prior to
the procedure. I have signed that consent voluntarily and with my free will. And I have had an opportunity to ask questions and have
them answered to my satisfaction. In that context, a complaint to the Division of Medical Quality Assurance, founded on any such
realized risks, unless there is clear and convincing evidence to the contrary, will be construed as bad faith.
3. Next, should a complaint be filed with the Division of Medical Quality Assurance related to standard of care, I, the patient, will
explicitly request that the complaint be reviewed by a member of my specialty; that specialty being Neurosurgery, Spinal Surgery,
Orthopedic Surgery, Pain Management or Neurology.
4. Finally, should the complaint allege facts that can be disrupted by the clear medical record, I, the patient, will voluntarily withdraw my
complaint if that portion of the medical record is drawn to my attention. I will have the right to inspect and review the medical record to
correct any perceived error in the medical history. Such corrections must be performed within two weeks of the treatment received
3. Resolution of Concerns
I understand that I am entering into a contractual relationship with Physician(s) of Millennium Medical Management for professional care. I further
understand that meritless and frivolous claims for medical malpractice have an adverse effect upon the cost and availability of medical care to
patients and may result in irreparable harm to a medical provider. As additional consideration for professional care provided to me by Physician,
I, the patient/guardian and/or my representative, agree not to initiate or advance, directly or indirectly, any false, meritless, and/or frivolous
claim(s) of medical malpractice against Physician. Furthermore, should a meritorious medical malpractice case or cause of action be initiated or
pursued, I (the patient) and/or my representative agree to use American Board of Medical Specialties (“ABMS”) board-certified expert medical
witness (es) in the same specialty as Physician. Furthermore, I agree that these expert witnesses will be members in good standing of and adhere
to the guidelines and/or code of conduct defined for expert witnesses by the AmericanBoard of Neurosurgery, American Board of Interventional Pain Management, American Academy of Pain
Management, American Board of Electrodiagnostic Medicine, American Board of Physical Medicine and Rehabilitation, American Board of
Orthopeadic Surgery and American Board of Psychiatry and Neurology.
Patient/guardian and Physician acknowledge that monetary damages may not provide an adequate remedy for breach of this Agreement. Such
breach
may result in irreparable harm to Physician’s reputation and business. Patient/guardian and Physician agree in the event of a breach to allow
specific performance and/or injunctive relief.
4. Waiver
Article 1, Section 21 of the Florida Constitution reads as follows: Access to court – The courts shall be open to every person for redress of any
injury, and justice shall be administered without sale, denial or delay. The Undersigned patient understands and acknowledges that: I have been
advised that signing this waiver releases an important constitutional right; and I h ave been advised that I may consult with counsel before signing
this waiver; and by signing this waiver I agree that if any controversy arises out of or in any way relating to the current, future or past diagnosis,
treatment, or care that I have or will receive from Millennium Medical Management, LLC, it’s physicians, agents or employees or Surgery Center of
Viera, LLC, the maximum amount of any non-economic damages that can be awarded in any such action will be $250,000. This limit applies
regardless of the number of claimants or defendants in the proceeding. There is no limit on the amount of economic damages that a jury may
award; and I have three (3) business days following execution of this waiver in which to cancel this waiver; and I wish to en gage the medical
services of Millennium Medical Management, but I am unable to do so because of the provisions of the constitutional limitatio n set forth above.
In
consideration of the physician or group of physicians’ agreements to provide medical services to me and my desire to receive medical services from
the physician or group of physicians listed below, I hereby knowingly, willingly, and voluntarily waive the right, in an action in a court of law for any
controversy, including any malpractice claim, arising out of or in any way relating to the diagnosis, treatment, or care of the patient by Millennium
Medical Management, including any partners, agents, employees of the physician or Surgery Center of Viera, LLC, to recover non-economic
damages in excess of $250,000; and I have selected Millennium Medical Management as my physician group of choice in this matter and would not
be able to retain their medical services without this waiver; and I expressly state that this waiver is made freely and voluntarily, with full knowledge
of its terms, and that all questions have been answered to my satisfaction. I understand that this waiver will remain in effect for one year from the
date that I have signed this form.
ACKNOWLEDGEMENT BY PATIENT FOR PRESENTATION TO THE COURT
The undersigned patient hereby acknowledges, under oath, the following:
I have read and understand this entire waiver of my right under the constitutional provision set forth above. I am not under the influence of any
substance, drug, or condition (physical, mental, or emotional) that interferes with my understanding of this entire waiver in which I am entering
and all the consequences thereof. I have entered into and signed this waiver freely and voluntarily.
I authorize Millennium Medical Management to present this waiver to the appropriate court, if required. Unless the court requires my attendance
at a hearing for that purpose,
Millennium Medical Management is authorized to provide this waiver to the court for its consideration without my
presence.
