Common Medication Side Effects

Common Medication Side Effects — Education & Service Agreement

Service Provider:      Client Name:      Effective Date:

WHEREAS

WHEREAS, the Service Provider is experienced in preparing, reviewing and delivering written medication safety and side-effect education materials intended to inform patients and clients regarding common adverse effects associated with prescribed medications; and

WHEREAS, the Client seeks to receive and review such educational materials and to engage the Service Provider for document preparation and counseling related to common medication side effects under the terms set forth herein.

SCOPE OF WORK

The Service Provider shall prepare and deliver a written educational handout titled "Common Medication Side Effects" customized to the Client's listed medications, conduct a review with the Client addressing expected, frequent and serious adverse effects, and provide reasonable follow-up clarification for questions reasonably related to the provided materials during the Term.

COMMON MEDICATION SIDE EFFECTS REFERENCE

The following list summarizes common adverse effects by medication class. This reference is educational in nature and not a substitute for clinical judgment. The Client acknowledges receipt of the listed categories applicable to the Client's medication regimen as checked below.

  Gastrointestinal (e.g., nausea, vomiting, diarrhea, constipation, abdominal pain)

  Central Nervous System (e.g., dizziness, drowsiness, insomnia, headache, confusion)

  Cardiovascular (e.g., palpitations, increased blood pressure, orthostatic hypotension)

  Dermatologic (e.g., rash, pruritus, photosensitivity)

  Allergic / Hypersensitivity (e.g., hives, angioedema, anaphylaxis — seek immediate care)

  Other (as specified in the medication record)

PATIENT / CLIENT MEDICATION RECORD

Has the Client experienced any side effects from this medication?    Yes    No

PAYMENT TERMS

The Client agrees to pay the Service Provider the fees set forth below in exchange for the Services described in this Agreement.

Late payments shall incur the stated late fee and reasonable collection costs, including attorneys' fees, and may accrue interest as specified above. Payment obligations that survive termination include unpaid fees and reasonable costs of collection.

TERM AND TERMINATION

This Agreement commences on the Effective Date and continues until the End Date below, unless earlier terminated in accordance with this section.

Either party may terminate for material breach if the breaching party fails to cure within the notice period specified above. Termination does not relieve either party of obligations accrued prior to termination, including payment and confidentiality obligations which shall survive termination.

CONFIDENTIALITY

Each party agrees to maintain in confidence all non-public information disclosed by the other party in connection with this Agreement that is designated confidential or that should reasonably be understood to be confidential given the nature of the information and the circumstances of disclosure. Confidential information does not include information that is or becomes publicly available through no breach, is independently developed, or is required to be disclosed by law; provided the disclosing party is given prompt notice to permit a protective order or other remedy. Remedies for breach include injunctive relief and damages.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State chosen by the parties below, without regard to conflict of law principles. Any dispute arising under or relating to this Agreement shall be brought exclusively in the state or federal courts of the selected state, and the parties submit to personal jurisdiction therein.

ENTIRE AGREEMENT

This Agreement, together with any attachments and written amendments executed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, representations and communications, whether oral or written. No amendment is effective unless in a writing signed by both parties.

ACKNOWLEDGMENTS

The Client acknowledges that the educational materials provided describe common and potential side effects and that not all possible adverse effects are listed. The materials are informational and do not replace direct medical advice. The Client agrees to consult the prescribing provider promptly for any serious or concerning symptoms.

Client has reviewed the applicable checked categories and the specific medication record above and has had an opportunity to ask questions. Client acknowledges receipt of the educational materials listed in this Agreement.    Acknowledged

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