Referral program for health professionals

Advanced Rejuvenation Clinic Ste-Thérèse Inc.
Effective date: January 2, 2025

Introduction and goals

1.1 These terms and conditions (hereinafter the”Conditions”) govern the professional reference program (the”Program”) established by Clinique Avancée de Réjuvenation Ste-Thérèse Inc. (hereinafter”MAP” or the”Clinic”).

1.2 The Program aims to facilitate interprofessional collaboration to optimize the management of patients requiring specialized care for dry eye, chalazion, stye, and blepharitis.

Services offered

2.1 The services offered by the CARE Clinic are exclusively limited to the following evaluations and treatments:

  • Evaluation and treatment of dry eye including growth factor-rich plasma (PRGF)
  • Chalazion or stye evaluation and treatment
  • Management of blepharitis

2.2 The Clinic expressly undertakes not to provide:

  • General eye exams
  • Any other regular optometric service
  • Any service competing with those offered by the referring professional

Co-management fees

3.1 Fee structure:

  • Complete dry eye assessment: $50
  • Chalazion or stye evaluation: $50
  • Blepharitis treatment: $30

3.2 Co-management fees are paid to cover:

  • Administrative coordination of care
  • Documentation and file follow-up
  • Interprofessional communication
  • Clinical data management

3.3 Payment terms:

  • Fees are recorded only when the patient actually shows up for the appointment.
  • Payment is made monthly for all qualified references from the previous month
  • Payment is made by direct deposit

Referral process and documentation

4.1 Required documentation:

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For each referred patient, the Participating Professional must provide:

  • Basic patient contact information
  • The specific reference pattern
  • Any medical information relevant to the proposed treatment

4.2 Tracking system:

  • Each reference receives a unique traceability code
  • The Participating Professional has access to a secure online portal allowing to:
    • Track the status of references in real time
    • Consult the reference history
    • Check the status of co-management fees

4.3 Ethical restrictions:

  • The Participating Professional undertakes not to refer:
    • Patients currently under his care for the same conditions
    • Patients who have consulted in the last six (6) months for the same conditions
  • Any referral should be medically justified and in the best interests of the patient.

CARE commitments

5.1 CARE expressly undertakes to:

  • Not to offer Referred Patients services other than the Eligible Services specifically mentioned in this Agreement.
  • Do not refer Patients to other clinics offering services similar to those of the Referrer.
  • Respect the professional relationship existing between the Referrer and the Referred Patient.
  • Maintain transparent communication with the Referrer regarding the status of referrals.
  • Protect the confidentiality of information relating to Referred Patients.

Confidentiality and data protection

6.1 The parties undertake to:

  • Maintain the strict confidentiality of all information exchanged as part of the program.
  • Comply with all applicable laws and regulations concerning the protection of personal data and medical confidentiality.
  • Implement appropriate security measures to protect patient data.

Changes and communications

7.1 Changes to the Program:

  • CARE reserves the right to change the terms of the program upon thirty (30) days' written notice.
  • The changes will be communicated to the Referrer by email at the address provided in the registration form.

General provisions

This Agreement does not create any employment, partnership, or joint venture relationships between the parties. The Referent acts as an independent professional.

Declarations and warranties

9.1 CARE responsibilities:

  • Maintaining an effective and secure reference system
  • Fast processing of referrals received
  • Patient data protection
  • Compliance with deadlines for the payment of co-management fees
  • Maintaining high standards of quality and safety in the provision of services

9.2 Responsibilities of the referring professional:

  • Providing accurate and complete information
  • Maintaining the confidentiality of information
  • Proactive communication of any relevant changes