Health Care Arbitration Agreement
In following the 710 ILCS 15/ Health Care Arbitration Act, is applied if any injuries are alleged to have been received by the signed patient or death of patient, due to health care provider negligence or other wrongful act, but not including intentional torts.
It is understood that any dispute as to medical malpractice, that is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered, will be determined by submission to arbitration as provided by Illinois law, and not by a lawsuit or resort to court process except as Illinois law provides for judicial review of arbitration proceedings. Both parties to this contract, by entering into it, are giving up their constitutional right to have any suck dispute decided in a court of law before a jury/judge, and instead are accepting the use of arbitration.
Specific cause for which services are provided are indicated by the consent for treatment date and patient documentation and paperwork for those indicated treatment dates.
In the case of a minor, the signature of the minor’s parent and/or guardian will be indicated on the patient paperwork.
Agreement to Arbitrate Health Care Negligence Claims Notice to Patient. You cannot be required to sign this agreement in order to receive treatment. By signing this agreement, your right to trial by a jury or a judge in a court will be barred as to any dispute relating to injuries that may result from negligence during your treatment or care, and will be replaced by an arbitration procedure. This agreement may be cancelled within 60 days of signing or 60 days after your hospital discharge or 60 days after your last medical treatment in relation to health care services not rendered during hospitalization. This agreement provides that any claims which may arise out of your health care will be submitted to a panel of arbitrators, rather than to a court for determination. This agreement requires all parties signing it to abide by the decision of the arbitration panel.
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