Additional Family Member Intake

This policy explains how additional family members may be enrolled under a primary membership account with Oak Concierge Medicine.

1. Primary Account Holder

Each household membership must designate one Primary Account Holder. The Primary Account Holder is the individual who:

Executes the Direct Health Care Agreement

Maintains the payment method on file

Is financially responsible for all enrolled family members

Receives billing notices and account-related communications

Only one Primary Account Holder is permitted per household account.

2. Eligibility of Additional Family Members

Eligible additional family members may include:

A spouse or domestic partner

Dependent children

Other dependents residing in the same household, subject to Practice approval

Oak Concierge Medicine reserves the right to approve or decline enrollment of any family member based on clinical capacity, scope of services, or other operational considerations.

3. Individual Consents Required

Each enrolled family member must have their own individual consent and intake documentation, including but not limited to:

Consent to Treat

HIPAA Acknowledgment

Telehealth Consent

Medical history and intake information

Consents may not be shared among family members. This requirement applies to both adults and minors and is necessary to comply with privacy and medical record regulations.

4. Minors

For minor children:

A parent or legal guardian must complete and sign all required consents on the minor’s behalf.

The signing adult represents that they have legal authority to consent to medical treatment for the minor.

One parent or guardian may consent for multiple minor dependents enrolled under the same account.

Upon reaching the age of majority, the individual may be required to execute their own consents and may be transitioned to a separate membership if applicable.

5. Financial Responsibility

The Primary Account Holder acknowledges and agrees that:

They are financially responsible for all membership fees, services, charges, and applicable fees for each enrolled family member.

Monthly membership fees for family members are billed together under the Primary Account Holder’s payment method.

Fees are billed automatically on a recurring monthly basis beginning on each family member’s enrollment date, unless otherwise specified in writing.

All payments are processed securely through Stripe, the Practice’s third-party payment processor.

Oak Concierge Medicine does not store full credit card or bank account information.

6. Changes to Family Membership

The Primary Account Holder must notify the Practice in writing of any changes, including:

Adding a family member

Removing a family member

Changes in legal guardianship

Changes in household status

Additional family members added after the initial enrollment may be subject to prorated fees and must complete all required documentation before services are provided.

7. Removal or Termination of a Family Member

A family member may be removed from the membership by written request from the Primary Account Holder, subject to:

Any applicable minimum commitment terms

Proration rules described in the Direct Health Care Agreement

Removal of a family member does not automatically terminate the household membership or the obligations of the Primary Account Holder.

8. Scope of Services

Each enrolled family member is entitled to the services described in the Direct Health Care Agreement and Appendix A, subject to the same limitations, exclusions, and disclaimers applicable to all Members.

Membership does not cover services provided by third parties, including hospitals, specialists, laboratories, imaging centers, pharmacies, or emergency services.

9. Privacy and Confidentiality

Each family member’s medical information is maintained in a separate medical record and is protected under HIPAA.

Medical information will not be shared between family members without proper authorization, even when enrolled under the same household account, except as permitted by law.

10. Governing Terms

This Additional Family Member Policy is incorporated into and governed by the Direct Health Care Agreement. In the event of a conflict, the terms of the Direct Health Care Agreement shall control.

I hereby authorize Oak Concierge Medicine and its healthcare providers to evaluate, diagnose, and treat my minor child for routine, urgent, or medically necessary care. This includes physical examinations, diagnostic testing, preventive services, treatment of illnesses or injuries, and any other care determined appropriate by the provider.

I understand that treatment may be provided through in-person visits or telehealth, when clinically appropriate. I acknowledge that reasonable efforts will be made to keep me informed of my child’s condition, treatment recommendations, and follow-up needs.

By providing this consent, I affirm that I am the parent or legal guardian of the minor and have the lawful authority to authorize medical treatment on their behalf. I understand that this consent remains in effect until revoked in writing.