Medical Service Arbitration Agreement
Idaho Diabetes and Endocrine Associates, P.A., A medical corporation agrees to provide to the undersigned
patient medical and related health care services in consideration for payments of a fee for service basis, fees as
charged by Idaho Diabetes and Endocrine Associates, P.A.
Article I
It is understood that nay 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 the American Arbitration Association, as provided by Idaho law, and not by a
lawsuit or resort to court proceedings, except as Idaho 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
such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration as the sole
means of dispute resolution.
Article II
Said agreement for arbitration, as provided in Article I of the agreement, shall apply to the owners, agents,
representatives and employees, successors in interest and staff physicians of Idaho Diabetes and Endocrine
Associates, P.A. and to the patient whether or not a minor, his heirs at law, personal representatives and any
claim in tort, contract or equity. Within 30 days after any of the party’s gives notice to the other of demand for
arbitration of any controversy, the parties to the controversy shall give notice to the American Arbitration
Associations then in effect. All notices or other papers required to be served shall be served y U.S. mail,
registered or certified, return receipt requested.
Article III
Idaho Diabetes and Endocrine Associates, P.A., and its employees and agents, agree to provide such medical
service as in the opinion of its Medical Care Providers are reasonably necessary and appropriate
notwithstanding the opinion of any third party payer. Should the patient, for reasons personal to himself, refuse
to accept the procedures, medications, or course of treatment recommended by its physicians, and if the MD
believed that no professionally acceptable alternative exists, and if after being so advised the patient still refuses
to follow the recommended course of treatment, then the patient shall be given no further treatment and neither
Idaho Diabetes and Endocrine Associates, P.A., nor its medical employees and agents, shall have any further
responsibility to provide services for the condition under treatment after notice of same is given to the patient.
Notice: By signing this contract you are agreeing to have any issue of medical malpractice decided by
neutral arbitration and you are giving us your right to a jury or court trial. See article I of this contract.
Patient ________________________________________ Date ___________________
______________________________________________ Date ___________________
Parent, Guardian, Spouse, Next of Kin
Witness _______________________________________ Date ___________________