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It outlines the structure for resolving outstanding account balances, including fields for patient identification, specific balance amounts, and agreed-upon payment frequencies, whether weekly or monthly. The agreement mandates that patients maintain ongoing payments for new services alongside their installments for past-due balances. It includes explicit terms regarding potential collection actions in the event of default and clarifies that this agreement is separate from any pharmacy-related charges, which require a distinct arrangement. 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I understand that I must make my nominal fee payments on the dates of service in addition to my monthly payment toward my past due balance. My failure to make payments without notification to the Billing Department at Partnership Health Center may result in further collection action on your account balance. Partnership Health Center will have full discretion for unpaid accounts and will take necessary action to collect any unpaid balances. **  \n**I also hereby acknowledge that this payment agreement does not include any balance I may owe in the Pharmacy and I understand that I will be required to establish a separate payment agreement for any balance due with the Pharmacy. **  \nPatient or Responsible Party Signature Date","cbCaiu6D1fpEsOAw","https://ap.wps.com/l/cbCaiu6D1fpEsOAw","pdf",327095,"English","# Payment Plan Agreement Overview\n## Patient and Account Information\n## Payment Schedule Terms\n## Terms of Agreement and Collection Policy\n## Pharmacy Payment Disclaimer","[{\"question\":\"Are there additional payment requirements beyond the monthly installment?\",\"answer\":\"Yes, patients must continue to pay nominal fees for any current services rendered on the date of service, in addition to the agreed-upon monthly payment toward their past-due account balance.\"}]","Payment Plan Agreement - Clinical | PDF",1789630678]