And Financial Agreement Sample Contracts

PATIENT CONSENT AND FINANCIAL AGREEMENT
And Financial Agreement • March 31st, 2021

Welcome to Kalispell Regional Healthcare (“KRH”). Thank you for choosing us for your care and treatment. KRH is an integrated health system that includes a number of organizations and Healthcare Services providers. Your consent covers services provided at the following KRH entities: Kalispell Regional Medical Center, Brendan House, The Summit, Kalispell Regional Behavioral Health, The Newman Center.

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BC FIRST NATIONS GAMING REVENUE SHARING LIMITED PARTNERSHIP
And Financial Agreement • September 17th, 2020

Until a more comprehensive study of remoteness can be completed, Indigenous Services Canada’s geo-zone classification system is the basis for determining the remoteness of Eligible First Nations communities. Geo-zone information can be found under the General Information/Geography link located on the First Nation Profile provided for each First Nation in British Columbia.9 This geo- zone information is sourced from the Band Classification Manual10 and is updated annually by Canada.11

PATIENT CONSENT AND FINANCIAL AGREEMENT
And Financial Agreement • June 25th, 2021

Welcome to Logan Health. Thank you for choosing us for your care and treatment. Logan Health is an integrated health system that includes a number of organizations and Healthcare Services providers. Your consent covers services provided at all Logan Health entities.

KALISPELL REGIONAL HEALTHCARE PATIENT CONSENT AND FINANCIAL AGREEMENT
And Financial Agreement • December 31st, 2018

Welcome to Kalispell Regional Healthcare (“KRH”). Thank you for choosing us for your care and treatment. KRH is an integrated health system that includes a number of organizations and Healthcare Services providers. A list of the KRH organizations and services offered is being provided to you along with this Patient Consent and Financial Agreement (“Agreement”).

PATIENT RESPONSIBILITY AND FINANCIAL AGREEMENT
And Financial Agreement • March 19th, 2014
Patient Consent to Treat and Financial Agreement
And Financial Agreement • March 6th, 2020

Consent to Treat: I authorize Zion Wellness Center, LLC and their successors and assigns, and clinical staff, to provide medical treatment for me/the patient named on this consent form.

PATIENT CONSENT AND FINANCIAL AGREEMENT
And Financial Agreement • February 8th, 2016

Welcome to Kalispell Regional Healthcare (“KRH”). Thank you for choosing us for your care and treatment. KRH is an integrated health system that includes a number of organizations and Healthcare Services providers. Your consent covers services provided at the following KRH entities: Kalispell Regional Medical Center, The HealthCenter, Brendan House, The Summit, Northwest Orthopedics and Sports Medicine, Kalispell Regional Behavioral Health, The Newman Center.

Tsunami Swimming Pro-Rated Competitive Team Contract and Financial Agreement
And Financial Agreement • December 28th, 2021

(parent/guardian), of the swimmers listed below for participation on the Tsunami Swimming Competitive team. This contract is effective through May 27, 2022.

POLICY STATEMENT AND FINANCIAL AGREEMENT
And Financial Agreement • January 6th, 2014
BC FIRST NATIONS GAMING REVENUE SHARING LIMITED PARTNERSHIP
And Financial Agreement • August 1st, 2019
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