Contract - Agregment 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.
Client’s Personal, Demographic, Health Insurance, Medical & Legal Information.
Name:  
  Last Name :
  First Name :
Sex:
Male: Female :
Age:
Soc. Security #
Address:  
  City :
  State :
  Contry & Zip Code:
Phone Home :
Phone Work :
E-mail :
Passport # :
Insurance :
Policy # :
Allergies :
Present Diagnoses :
Medication & dosages :
   
Physician’s Name : Phone:
Emergency Contacts:  
  Name :
  Home Phone :
  Work Phone :
  E-mail :

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)

• PICK-UP & DROPP OFF SERVICE : 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

8.-Iportant: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:
• North City Limit : The Emerald Bay Resort / El Delfín Apts.
• South City Limit: Café Marino Factory.
• East City Limit: Cervecería Corona.
• 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.

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