Elysium Rehabilitation Center

1. Subject of the Contract:

1.1 The clinic undertakes the obligation, based on the inpatient narcological department, under the supervision of the specialized doctor: (Specialization/Name/Surname) ______________________, to provide medical services necessary for the treatment of diseases caused by the use of narcotic, psychoactive, and/or alcoholic substances.

1.2 The patient and/or their representative, in accordance with Article 3 of this agreement, undertakes to ensure the payment of the cost of the medical services specified in 1.1, under the terms and conditions established by this contract.

2. Disease Diagnosis:

2.1 Diagnosis: ____________________________________________________________________________

2.2 Duration of Treatment (Preliminary): _____________________________________________________

3. Financial Relations / Cost of Medical Services / Payment Procedures:

3.1 The cost of medical services provided under this contract amounts to __________ (numeric) ____________ (written) GEL for the period specified in clause 2.2.

3.2 Payment for treatment costs is made in cash/non-cash form.

3.3 After signing this contract, the patient and/or their representative shall provide full payment of the amount specified in 3.1 to the clinic's bank account or pay in cash at the clinic's cash desk.

3.4 Payment for the medical services specified in 3.1 can be made at the time of contract signing, before the actual start of treatment, and throughout the entire treatment period. In case of emergency, partial unpaid amounts can be deferred or installments arranged with prior approval from the head of the inpatient narcological department, based on a written agreement and financial responsibility guarantee. (This agreement is attached and forms an integral part of this contract).

3.5 If the patient is covered under a state health program, and the treatment is discontinued more than 2 weeks before the scheduled end date due to the patient’s initiative or violation of the internal rules of the respective department, and the state refuses reimbursement, the patient is obliged to pay the clinic the full cost of treatment based on the bed-day calculation according to internal standards, no later than 30 days after the refusal notification.

3.6 The clinic shall automatically refund any unutilized amount paid by the patient to the bank account specified by the patient (the recipient's account number/bank statement attached), without additional agreement, based on this clause.

4. Rights and Responsibilities of Parties:

4.1 The Patient is obliged to:

4.1.1 Provide the clinic staff with requested information, including personal and special category data, for ensuring the safety of the department and medical service delivery.

4.1.2 Not to consume alcohol, psychoactive substances, or narcotics during treatment without a doctor’s prescription.

4.1.3 Voluntarily surrender substances/objects that threaten health and safety of others, including personal belongings that conflict with the internal regulations of the clinic.

4.1.4 Undergo inspection/examination at the start of treatment upon request by the responsible persons of the department.

4.1.5 Participate in prescribed medical/recovery activities.

4.1.6 Maintain patient confidentiality.

4.1.7 Pay the cost of medical services within the specified deadlines.

4.1.8 Follow the internal regulations of the inpatient narcological department.

4.1.9 Comply with the requirements of medical staff and responsible persons regarding safety during the entire treatment period.

4.2 The Patient has the right to:

4.2.1 Discuss the treatment program and process with medical staff.

4.2.2 Fully understand the treatment program.

4.2.3 Fully understand and comply with the rules and requirements of the treatment program.

4.2.4 Request confidentiality in accordance with applicable laws.

4.2.5 Withdraw or refuse treatment with prior written notice.

4.3 The Clinic is obliged to

1.     Provide the Patient with a proper medical environment and conditions necessary for the treatment of diseases related to narcotic, psychoactive substances and/or alcohol.

2.     Ensure the confidentiality of the Patient’s medical information, except in cases provided by Georgian legislation.

3.     In the event of violation of the Clinic's regulations, inform the Patient and/or their Representative about the consequences of violations.

4.     In the event of a threat to the life or health of the Patient, immediately notify the Patient's Representative or emergency services.

4.4. The Clinic has the right to:

1.     Refuse the continuation of the service if the Patient violates the Clinic’s internal regulations, behaves aggressively, endangers the safety of others, or is found using prohibited substances during treatment.

2.     Conduct necessary inspections (such as personal belongings checks, screenings) to ensure the safe and proper environment within the Clinic.

3.     Require payment for the provided services in accordance with the agreed payment terms.

5. Entry into Force / Term of Agreement / Early Termination

5.1. This Agreement enters into force immediately upon its signing by both parties and remains effective until all obligations have been fulfilled.
5.2. The Agreement can be terminated early:

1.     At the Patient's request;

2.     Upon violation of the Agreement terms by the Patient or their Representative;

3.     If the Patient independently leaves the Clinic, refuses treatment, or violates the rules.
5.3. In case of early termination, the Clinic has the right not to refund the paid amount, except for unused services, in accordance with Section 3.

6. Special Conditions

6.1. The Clinic shall not be responsible for damages caused to the Patient as a result of hidden (unauthorized) use of narcotics, alcohol, psychoactive, psychotropic substances, medications or other similar substances, as well as injuries sustained in such a state.

6.2. The Clinic ensures full confidentiality of the Patient’s personal and medical information in accordance with applicable laws, except when disclosure is required by law.

6.3. The Patient is responsible for securing their own personal belongings; the Clinic shall not be liable for their loss.

7. Dispute Resolution

7.1. Any disputes arising from this Agreement shall be settled through negotiation between the parties.
7.2. If an agreement cannot be reached, the dispute shall be resolved in the court of Georgia in accordance with Georgian legislation.

8. Additional and Final Provisions

8.1. This Agreement is executed in two (or three) original copies in the Georgian/English language, having equal legal force.

8.2. Matters not regulated by this Agreement shall be governed by the legislation of Georgia.
8.3. Any annexes, appendices, or changes to the Agreement shall form an integral part of it and shall be valid if made in writing and signed by the Parties.