I acknowledge that no guarantees or warranties have been made with respect to treatment or services to be provided by UHC. I understand that all supplies, medical devices and other goods provided to Patient are provided by UHC AS IS and UHC disclaims any expressed or implied warranties.
I agree that if a UHC employee or provider is exposed to Patient’s blood or other bodily fluid, pursuant to Texas law, UHC may test Patient to determine the presence of communicable diseases including Human Immunodeficiency Virus (HIV) and hepatitis. I understand that these test results will be kept confidential.
I acknowledge that UHC may, in its sole discretion, remove, retain, or dispose of any tissue or body parts removed from Patient.
I agree to pay for the full billed charges associated with goods and services provided to Patient regardless of any applicable insurance or benefit payments and understand that all amounts are due upon request and are payable to UHC. I also agree and understand that if Patient’s account becomes delinquent and is referred to an attorney or agency for collection or suit, I will be responsible for paying all charges, reasonable attorney fees, costs, and collection expenses. An estimate of the anticipated charges is available upon request. I understand that estimates may vary significantly from the final charges because of a variety of factors such as the course of treatment, intensity of care, Provider practices, and the need to provide additional goods and services.