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(PLEASE,
PRINT IT BEFORE YOUR DEPARTURE TO MAZATLAN)
Contract-
Agreement For Non- Resident Individuals
Emergency Management, Medical Emergency, Ambulance Complementary
Services, Medical & Foreign Health Insurance Advisory Services.
Liability
Policy.
"First Response" Agrees with "The Client", named
in the declarations made a part hereof, in consideration of the
payment of the premium and of the statements contained in the declarations
and subject to the limits of liability, exclusions, conditions,
and other terms of this policy.
1.-
Description of "First Response"
"First Response" is a legal enterprise with operations
in Mazatlan, Sinaloa, operated by "Tourist Medical Assist.
Co" providing Emergency Management, Medical Emergency, Ambulance
Complementary Services, Medical & Foreign Health Insurance Advisory
Services, and agrees to provide those services to "The Client"
under this policy services agreement.
2.-
Description of " The Client ".
"The Client" will be the person(s), adult (and minor)
who declares the above information is real and true and will be
registered into this policy under the following name (s) and agrees
& accept the terms and conditions of this policy and affirm
that is with the sole purpose to protect to him / her self or to
their family against eventual emergencies and health concerns.
IMPORTANT, Our medical staff will keep your information available,
please, feel safe providing to us, as much info as you can. Client's
Personal, Demographic, Health Insurance, Medical & Legal Information.
3.- Coverage: Only in the Mazatlan
Metro Area.
4.-
Duration of the Contract - Agreement & Expiration
Date: From your arrival thru your departure in the Mazatlan-Metro-Area.
The maximum length of coverage shall not exceed thirty (30) days.
5.-
Staff: All our services are provided by qualified professionals
in every different field.
6.-
Time to Respond: The time to respond can vary, and it
will depend on how serious every emergency is, However, The Staff
is committed to improve our services every day to satisfy our demanding
visitors´ s needs.
7.-
Description of the Offered Services: First Response Will
Provide.
- Local Bilingual
Emergency " CALL CENTER " Around-the-clock Phone-Assistance,
Direct Connection with our Emergency Services Staff, Emergency
Units Dispatchers, International Health Insurances (Only 800 #s
from Mazatlan), Police or Fire Station, Citizens Protection System,
International Embassies (Only 800#s from Mazatlan), or local Consulates
if required during an emergency.
- MINOR MEDICAL
EMERGENCIES, In Three Events Per Patient, at Hotel, Home or Apartment
All Pre-Hospital Urgent Care Services by Paramedics / Emergency
Physician that could be Managed Prior to Doctor's Office, Emergency
Room, or Hospital without any risk for the Patient / Client or
for the Physician / Surrender of Services Enterprise. Basic disposable
supplies are included; Pharmaceutical products, Medical supplies
and Orthopedic devices are not covered.
- MAJOR MEDICAL
EMERGENCIES, In Two Events Per Patient, at any place into Mazatlan
Metro Area, including All Pre-Hospital Urgent Care Services by
Paramedics, All Medical Assistance / Services On-Board, Complementary
Ambulance Transportation to the hospital and all medical services
until you are delivered to the ER or Hospital. *Basic Disposables,
Medication, Medical supplies or Orthopedic Devises are Included.
- TELEPHONE
MEDICAL ADVISE. Unlimited calls for reasonable health related
questions.
- Pick-Up Service
or Ambulatory Patients Transportation (Included)o PICK-UP &
DROPP OFF SERVICE : AMBULATORY PATIENTS TRANSPORTATION.
- ADMINISTRATION
ASSISTANCE (Bilingual) for Foreign Insurances procedure purposes
during Emergency Room or Hospital Admittance at any time, or once
in our facilities during your trip, by appointment.
8.-
Important: If you go out of Mazatlan-Metro-Area (Coverage
Area) we will ONLY provide you with phone Assistance during Major
Emergency Cases or Evaluate your Medical Condition, sending an Ambulance
(Not Included) to attend you into our Recommended Hospitals Network,
however in the event of admission into an out-of network hospital,
we can evaluate your case, advising you about the quality of services,
diagnostic, medical treatment and prognosis for that occurrence.
9.-
The End of an Emergency Service: is at the moment when
you have been attended by our Staff in your hotel, home or apartment
after a primary medical diagnossis. Or when you have been delivered
to a Hospital or to a professional Emergency Staff Member at the
Emergency Room or Hospital.
10.-
"The Client" / Patient Liability: (parents
if minor) are the only responsible to pay for: All the Not included
services like: Pharmaceutical products, Disposables, Medical supplies
and Orthopedic devices (not covered during a minor emergency); Or
the next Medical & Hospital Services, Pharmaceutical products,
Disposables, Medical supplies, Orthopedic devices and all the charges
that could be charged by the attendant Hospital when you are been
delivered at the Emergency Room or Hospital.
11.-
Recommended Network Of Provider of Services / Hospitals:
"First Response" recommends his own network of Physicians,
Specialists, Hospitals, Air Ambulances, Emergency Services Transportation
& Ambulance Services based on his professional experience working
together.
12.-
Health-Medical Foreign Insurance - Local Acceptance:
Our Network of Affiliated Services & Hospitals accepts and do
take International Medical Insurance with the limitations, restrictions
or exclusions of each policy, and each Hospital has it's own policy,
and your policy may has it, but First Response can not modify that
situation.
13.-About
Limitations. This Policy does apply only for Mazatlan-Metro-Area.
Delimitated: Intl. Airport " Gral. Rafael Buelna" to Mazatlan
City, Highway Round Trip, on your arrival and departure date.The
Mazatlan City limits that in this agreement will be:o North City
Limit : The Emerald Bay Resort / El Delfín Apts.o South City
Limit: Café Marino Factory.o East City Limit: Cervecería
Corona.o West City Limit: The Beach Side Pacific Ocean From: The
Sport Fishing Fleets Dock to Playa Bruja / Punta Cerritos.
14.-
Exclusion / Restriction of Services. Is ONLY the Area-Coverage,
our coverage is for Mazatlán-Metro-Area, However, at other
different areas or at other tourists´ s places that you may
go during your vacation, you ONLY will be assisted by our "Call
Center" and some Emergency Services can be arranged by our
Staff without any Liability for "First Response", and
those services are not included. Out of the metro-area we can send
one of our Ambulances ONLY during Major Emergencies, (if we consider
better you wait for us than other similar service attend your medical
situation immediately) or arrange a closer or similar service. The
time to respond can vary and will not be First Response responsibility
under any circumstance.
15.-
Assignment, Endorsement, and Extension:
This Policy non-transferable. However, it may be renewed one more
time after a new policy premium is paid.
16.-
Changes: Notice
to any agent or knowledge possessed: By any agent
or by any other person shall not effect a waiver or a change in
any part of this policy or stop the company from asserting any right
under the terms of this policy, or shall the terms of this policy
be waived or changed.
17.-
Liability: Our company policy
covers the delivery of Pre-Paid Emergency Medical Services, We are
not an insurance company. We cannot assume any financial liability
to pay or reimburse for Medical or Emergency Services included or
not in our contract, or for services rendered outside of our network
for any reason and under any circumstance.
18.-
Disclaimer:
First Response shall not be responsible under any circumstance for
any service out of the Mazatlan-Metro-Area, or by similar services
if provided by a different entity, makes no difference if it was
arranged or not by our "Call Center" or if you been out
of Mazatlan-Metro-Area or if you didn't have enough time or the
proper information available to contact us during an emergency.
We suggest you carry a copy of this policy on you all the time with
understandable information to Call Us in case of emergency.
For More
Information: ceo@hospitalbalboa.com
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